Oesophago–Gastric Cancer Audit National Oesophago–Gastric Cancer Audit Comparing local and national figures Hi I am Georgina Chadwick, I am gastroenterology SpR currently doing an OOPE at the RCS working as a research fellow on the NOGCA. I would like to briefly go through some of the new area considered in the 2014 Annual Report which is due to be published at the beginning of November.

This slide set is designed to help you audit your local trust practice against other Trusts in your SCN and vs National figures where appropriate. We have designed the slides so you just enter your data available from the Annexes in the appropriate space. Information for HGD cases from Progress Report Annexes.

Data submitted to NOGCA National Local Trust OG cancer Cases recorded 22,832 xx % case ascertainment 78.6% % NOGCA successfully linked with RTDS 90.6% HGD Oesophagus 465

Data completeness – Surgical records For surgical cases the NOGCA reviewed the completeness of records submitted to the audit. Including the use of ‘unknown’ for mandatory variables. Local Trust Number of surgical cases Surgical intent recorded (%) Complications recorded (%) Death in hospital recorded (%) Matched pathology record (%)

Data completeness – Pathology records Staging data is key in risk adjusting cases for monitoring surgical outcomes. Including the use of ‘unknown’ for mandatory variables. Local Trust T-stage recorded (%) N-stage recorded (%) M-stage recorded (%)

Surgical Outcomes National Local Trust Curative Surgery volume 4,898 xx Mortality rate 30-day 2.4% 90-day 4.4% Complication rate 27.7% On this slide you can compare your trusts mortality to national figures and highlight your own trust on the graph DELETE THIS BOX

Quality of surgery indicators With falling mortality associated with OG cancer surgery, focus needs to go towards monitoring quality of surgery. Adequate lymph node resection is needed for staging, and to increase the chance surgery is curative. Aim of surgery should be to achieve tumour free resection margins, otherwise patient is rarely =cured. National Local Trust Positive resection margin (%)* 26.7% Adequate lymph node resection (%) 89.2% Length of stay, median (days) 12 * Where both longitudinal and circumferential margin status known. 26.6% of patients did not have data recorded for both margins. ** >6 lymph nodes for oesophagectomy, >15 lymph nodes for gastrectomy

Surgery with adjunct oncology BSG guidelines Oesophageal cancer - Preoperative chemoradiation improves long- term survival over surgery alone. Gastric cancer - Perioperative combination chemotherapy conveys a significant survival benefit and is a standard of care. Proportion of patients with locally advanced disease managed surgically who received additional oncological therapy. On this slide you can highlight your SCNs adherence to BSG guidelines for use combination surgery and oncological treatment of OG cancer DELETE THIS BOX Allum W, Blazeby J, Griffin S, Cunningham D, Jankowski J, Wong R. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60(11):1449-72.

OG cancer in elderly 58.9% OG cancers diagnosed in patients aged 70yrs or over. Planned treatment intent (unadjusted) Age <70: 49.4% curative Age ≥ 70: 28.9% curative Variation in proportion of patients over 70 managed with curative intent across SCNs. On this slide you can highlight the proportion of elderly patients managed with curative intent in your SCN. If low consider whether steps need to be taken to ensure decisions regarding treatment intent based on disease extent and patients factors e.g. co-morbidities, irrespective of age of patient. DELETE THIS BOX

Early Cancers 5.4% OG cancers diagnosed at early stage (T0/1,N0,M0). Across SCNs significant variation in proportion of cancers diagnosed early. On this slide you can highlight the proportion of patients diagnosed at an early stage in your SCN. If low consider whether steps need to be taken to try and increase this figure in future e.g. targeting improving patient and GP awareness, ensuring easy access to endoscopy. DELETE THIS BOX

Contact Details For any queries please contact: Dr Georgina Chadwick Clinical Research Fellow The National Oesophago-Gastric Cancer Audit E-Mail: gchadwick@rcseng.ac.uk