National Audit of Breast Cancer in Older Patients (NABCOP) [Insert name of presenter] [Insert name of event] [Insert name of NHS organisation] 2019 Annual report @NABCOP_news www.nabcop.org.uk

Background Aim: To audit breast cancer care received by women aged 70+yrs in NHS organisations in England and Wales Compare care received with women aged 50–69 years NABCOP is a collaboration between ABS and RCSEng Commissioned by HQIP as part of the National Clinical Audit Patient Outcomes Programme (NCAPOP) Started in April 2016 Using existing national datasets provided by NCRAS (England) and CANISC (Wales) No audit-specific data entry required by NHS organisations For more information on NABCOP, see chapter 1 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ More information ABS – Association of Breast Surgery. The association that represents healthcare professionals treating malignant and benign breast disease in the UK, Ireland and worldwide. RCSEng -The Royal College of Surgeons of England is an independent professional body committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. As part of this it supports audit and the evaluation of clinical effectiveness for surgery. HQIP – Healthcare quality improvement Partnership. Aims to promote quality improvement in healthcare, and in particular to increase the impact of clinical audit on the services provided by the NHS and independent healthcare organisations. NCRAS - The National Cancer Registration and Analysis Service. Collects, analyses and reports on cancer data for the NHS population in England. CANISC - An all-Wales electronic patient record used for clinical management of cancer patients. NABCOP uses existing data items in National datasets to avoid burden of further data collection. Therefore, all NHS organisations in England and Wales participate in the audit, and no additional data entry is required for the audit. More information on the data sources can be found at: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_Methodology_2019.pdf @NABCOP_news

Year 3 (2019) Describes patterns of care between women aged 50-69yrs and 70+ years, in the following groups of breast cancer: DCIS Early invasive breast cancer (stage 1-3A) Metastatic breast cancer (Stage 4) This includes findings from the English Cancer Patient Experience (CPES) survey for patients diagnosed in 2015. https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/

Women included in the 2019 Annual Report Age 50+ years, diagnosed with breast cancer between 01 Jan 2014 and 31 Dec 2017 in England and Wales Invasive BC N = 131,495 (89%) DCIS BC N = 15,667 (11%) Advanced non-metastatic** BC N = 5,544 (4%) Early invasive* BC N = 109,018 (83%) Women with only one tumour, diagnosed with DCIS or invasive disease N = 147,162 * Early invasive = Stage 1-3A ** Advanced non-metastatic = Stage 3B, 3C *** Metastatic = Stage 4 Metastatic*** BC N = 6,550 (5%) Unknown stage N = 10,383 (8%) NHS organisation participation: English NHS trusts = 124 Welsh local health boards = 6 Figure 4.1: Flow diagram of patients included within NABCOP group. For more information, refer to page 8 in the NABCOP 2019 annual report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ @NABCOP_news

Distribution of disease severity (stage) by screen detected cancer status and age Figure 4.3: Distribution of disease severity (overall stage) by screen-detected cancer status and age at diagnosis For more information, refer to page 12 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ * in women diagnosed between 2014 – 2017

Availability of core data items: for women diagnosed in England in 2017 Total % available in England [insert the name of your NHS organisation] 50-69 yrs 70+ yrs All tumours (invasive / DCIS) Laterality 100% CNS contact 76% WHO performance status 53% Invasive tumours Grade Tumour stage 95% Nodal stage 94% Metastases stage Overall stage ER status 91% HER2 status 85% Whole tumour size 80% PR status 58% DCIS 97% Audit standards: NICE (2018) Ensure that the ER, PR and HER2 statuses are available and recorded at MDT meetings when systemic treatment is discussed. NABCOP recommendations: NHS organisations must ensure that the following information is uploaded to the national cancer registration services: Tumour size consistent with the entered T stage N stage, M stage ER status and HER2 status WHO performance status. NHS organisations should identify a clinician responsible for reviewing and checking their units’ data returns. Data completeness target = 90% Note: Data items are ordered within sections based on total % available (highest % to lowest %) For more information, see section 3 ‘Participation and data completeness’ in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `DQ_Summary’ – fill in the data completeness results of your NHS organisation Highlight the data items where your NHS organisation falls below 90% To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard

[insert NHS organisation name] Women diagnosed in 2017 Routes to diagnosis 50-69 years 70+ years Total number of patients (N) xxx DCIS % Invasive 50-69 years 70+ years GP referral % NHS screen programme Emergency presentation Other route Not reported For more information on routes to diagnosis, see chapter 5 ‘Diagnosis and supportive care’ in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation table for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Ind_Summary’ – fill in the number of patients diagnosed and data completeness results of your NHS organisation from the boxes above the graphs. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard

CNS contact reported as “yes” for women diagnosed in 2017 Audit standards: NICE (2018) All people with breast cancer should have a named CNS or other specialist key worker with equivalent skills, who will support them throughout diagnosis, treatment and follow-up. CNS contact reported as “yes” NABCOP recommendations: NHS organisations must ensure that: Women are assigned a named breast CNS to provide information and support. Data on the assignment of a named breast CNS are submitted to the national cancer registration services. For more information on involvement of breast CNS or key worker, see chapter 5.3 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp5_CNS’ To delete the current graph, click on the graph (i.e. on the bars) and press the `backspace’ key on your keyboard Copy the graph from the data viewer and paste the graph for your NHS organisation in the white box on the slide. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard

Risk-adjusted rates of surgery for DCIS (%) Ductal carcinoma in situ (DCIS)* Overall rate of surgery decreased with age 50–69 years: 93%, 70+ years: 81% Wider variation in the rate of surgery in women aged 70+ years in England and Wales, compared to women aged 50 - 69 years Audit standards: NICE (2018) Surgical resection is the most important treatment for DCIS NABCOP recommendations: There is a lack of strong evidence concerning the management of DCIS in older women. NHS organisations must ensure that Women are counselled appropriately about the gap in knowledge and guidelines, and place emphasis on treating patients with DCIS using a risk-based, rather than age-stratified, approach. Older women who undergo BCS for high-risk DCIS, and have few comorbidities or frailty, are considered for radiotherapy Risk-adjusted rates of surgery for DCIS (%) For more information on DCIS, see section 6 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp5_DCIS_Surgery’ To delete the current graph, click on the graph (i.e. on the bars) and press the `backspace’ key on your keyboard Copy the graph from the data viewer and paste the graph for your NHS organisation in the white box on the slide. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard * in women diagnosed between 2014 – 2017

Risk-adjusted rates of surgery for EIBC in women aged 70+ years (%) Early invasive breast cancer (EIBC): surgery* Overall rate of surgery decreased with age: 50–69 years: 95%, 70+ years: 74% Women aged 70+ years were more likely to receive surgery for ER-negative compared to ER-positive breast cancer, irrespective of measurement of fitness Audit standards: NICE (2018) Treat patients, irrespective of age, with surgery and appropriate systemic therapy, rather than endocrine therapy alone, unless significant comorbidity precludes surgery Risk-adjusted rates of surgery for EIBC in women aged 70+ years (%) NABCOP recommendations: Improving the data completion on the WHO performance status will enable better understanding of the reasons behind the variation in the patterns of primary surgery. NHS organisations must ensure that: medical optimisation of women with ER-positive EIBC is instituted to maximise potential for their suitability for surgery. For more information on surgery early invasive BC, see section 7.1 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_Surgery’ To delete the current graph, click on the graph (i.e. on the bars) and press the `backspace’ key on your keyboard Copy the graph from the data viewer and paste the graph for your NHS organisation in the white box on the slide. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard * in women diagnosed between 2014 – 2017

[insert the name of your NHS organisation] ER-positive ER-negative Risk-adjusted % of women aged 70+ years receiving surgery for early invasive breast cancer (EIBC), by diagnosing NHS organisation and ER status There was variation across NHS organisations in the percentages of women aged 70+ years who received breast surgery for early invasive breast cancer (Figure 7.2) - For more information on surgery early invasive BC, see section 7.1 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ For more information on how to present this graph, see the section ‘Interpreting figures within the report: pyramid plots’ in the Supplementary guide for the 2019 Annual report: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_SupplementaryGuide.pdf For more information on the risk-adjustment, see the ‘risk adjustments’ section in the 2019 Annual report methodology document: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_Methodology_2019.pdf To identify your NHS organisation on this graph: Refer to Appendix 2 ‘NHS providers and geographical regions’ in the 2019 Annual report to find the provider code of your NHS trust Magnify this slide to a minimum of 200% to allow you to identify the provider code of your NHS Trust on the ‘y-axis (vertical)’ Move the blue arrow to indicate where your trust lies on this graph To delete the yellow star marker and text before your presentation, click on the items and press the `backspace’ key on your keyboard If you require more exact local data values: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_surgery’ – and your trust will be highlighted [insert the name of your NHS organisation] @NABCOP_news

Early invasive breast cancer (EIBC): radiotherapy (RT) * Overall, 89% of women received RT post-BCS: 91% in 50-69 years, 84% in 70+ years Overall, 64% of women received RT post-Mx for high risk EIBC: 67% in 50-69 years, 60% in 70+ years Audit standards: NICE (2018), RCR (2017) Consider RT for all patients undergoing BCS for EIBC Omission of RT may be appropriate for women who are low-risk RT following mastectomy for women with moderate or high-risk of recurrence (N+ or T3-4 N0) Post-BCS RT Post-Mx RT * NABCOP recommendations: NHS organisations must ensure that: Women with high-risk EIBC are counselled on the benefit and risk of adjuvant radiotherapy based on tumour characteristics and objective assessment of patient fitness, rather than chronological age alone. For more information on radiotherapy early invasive BC, see section 7.2 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_RT’ To delete the current graph, click on the graph (i.e. on the bars) and press the `backspace’ key on your keyboard Copy the graph from the data viewer and paste the graph for your NHS organisation in the white box on the slide. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard * in women diagnosed between 2014 – 2017

BCS Mastectomy Observed % of women with EIBC receiving RT after surgery, by diagnosing NHS organisation, age at diagnosis and type of surgery [insert the name of your NHS organisation] There was variation in the rate of post-BCS and post-mastectomy RT between NHS organisations (Figure 7.6) - For more information on radiotherapy early invasive BC, see section 7.2 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ For more information on how to present this graph, see the section ‘Interpreting figures within the report: pyramid plots’ in the Supplementary guide for the 2019 Annual report: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_SupplementaryGuide.pdf For more information on the risk-adjustment, see the ‘risk adjustments’ section in the 2019 Annual report methodology document: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_Methodology_2019.pdf To identify your NHS organisation on this graph: Refer to Appendix 2 ‘NHS providers and geographical regions’ in the 2019 Annual report to find the provider code of your NHS trust Magnify this slide to a minimum of 200% to allow you to identify the provider code of your NHS Trust on the ‘y-axis (vertical)’ Move the blue arrow to indicate where your trust lies on this graph To delete the yellow star marker and text before your presentation, click on the items and press the `backspace’ key on your keyboard If you require more exact local data values: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_RT’ – and your trust will be highlighted @NABCOP_news

Risk adjusted rates of chemotherapy (%) Early invasive breast cancer (EIBC): chemotherapy (CT) * In women with ER-negative, HER2-negative, N+ EIBC 53% had adjuvant CT 73% in 50-69 years, 30% in 70+ years In women with HER2-positive EIBC who received surgery, 59% had CT and trastuzumab: 69% in 50-69 years, 36% in 70+ years Audit standards: NICE (2018), ESMO (2015) Adjuvant CT decisions should be based on an understanding of the balance between the risks and benefits particularly in people with comorbidities. CT and trastuzumab is recommended for women with HER2-positive BC, regardless of ER status. Risk adjusted rates of chemotherapy (%) NABCOP recommendations: NHS organisations must ensure that: All women, irrespective of age, with: (1) ER-negative, HER2-negative EIBC with malignant lymph nodes, or (2) HER2-positive EIBC; have an objective assessment of likelihood of benefit and risk of chemotherapy based on tumour factors and patient fitness. They evaluate their services for medical optimisation of older women, who would benefit from receiving chemotherapy. For more information on chemotherapy early invasive BC, see chapter 7 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_CT’ To delete the current graph, click on the graph (i.e. on the bars) and press the `backspace’ key on your keyboard Copy the graph from the data viewer and paste the graph for your NHS organisation in the white box on the slide. To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard * in women diagnosed between 2014 – 2017

50 – 69 years 70+ years Risk-adjusted % of women with HER2-positive EIBC receiving adjuvant chemotherapy + trastuzumab, by diagnosing NHS organisation and age at diagnosis [insert the name of your NHS organisation] There was variation in the uptake of chemotherapy + trastuzumab for women with HER-2 positive EIBC between NHS organisations (Figure 7.10) - For more information on chemotherapy early invasive BC, see section 7.3 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ For more information on how to present this graph, see the section ‘Interpreting figures within the report: pyramid plots’ in the Supplementary guide for the 2019 Annual report: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_SupplementaryGuide.pdf For more information on the risk-adjustment, see the ‘risk adjustments’ section in the 2019 Annual report methodology document: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_Methodology_2019.pdf To identify your NHS organisation on this graph: Refer to Appendix 2 ‘NHS providers and geographical regions’ in the 2019 Annual report to find the provider code of your NHS trust Magnify this slide to a minimum of 200% to allow you to identify the provider code of your NHS Trust on the ‘y-axis (vertical)’ Move the blue arrow to indicate where your trust lies on this graph To delete the yellow star marker and text before your presentation, click on the items and press the `backspace’ key on your keyboard If you require more exact local data values: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_CT’ – and your trust will be highlighted @NABCOP_news

Risk-adjusted rates of chemotherapy for metastatic BC (%) Metastatic breast cancer* 5% of women had metastatic BC at presentation 3% in 50-69 years, 7% in 70+ years ER-status was unknown for: 23% in 50-69 years, 28% in 70+ years Women aged 70+ years were less likely to receive CT irrespective of fitness or ER status 59% of women aged 50-69 years, 24% Audit standards: NICE (2009) Offer endocrine therapy as first-line treatment for the majority of patients with ER-positive advanced BC. Offer CT as first-line treatment for patients with ER-positive advanced BC whose disease is imminently life-threatening or requires early relief of symptoms. For patients with ER-positive advanced breast cancer who have been treated with CT, offer endocrine therapy following the completion of CT. Risk-adjusted rates of chemotherapy for metastatic BC (%) NABCOP recommendations: NHS organisations must ensure that ER status is assessed and recorded for women with metastatic breast cancer. All women who are ER-positive should be offered endocrine therapy. Consideration of chemotherapy for women with metastatic breast cancer is based on an objective assessment of likelihood of benefit, health and predicted life expectancy rather than chronological age alone. For more information on chemotherapy early invasive BC, see section 7.3 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ Instructions: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_EIBC_CT’ To delete the current graph, click on the image and press the `backspace’ key on your keyboard Copy and paste the graph for your NHS organisation To delete the yellow star marker before your presentation, click on the item and press the `backspace’ key on your keyboard * in women diagnosed between 2014 – 2017

50 – 69 years 70+ years Risk-adjusted % of women with newly-diagnosed metastatic breast cancer receiving chemotherapy, by age at diagnosis [insert the name of your NHS organisation] There was variation in the uptake of chemotherapy + trastuzumab for women with HER-2 positive EIBC between NHS organisations (Figure 8.1) - For more information on metastatic breast cancer, see section 8 in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ For more information on how to present this graph, see the section ‘Interpreting figures within the report: pyramid plots’ in the Supplementary guide for the 2019 Annual report: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_SupplementaryGuide.pdf For more information on the risk-adjustment, see the ‘risk adjustments’ section in the 2019 Annual report methodology document: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_Methodology_2019.pdf To identify your NHS organisation on this graph: Refer to Appendix 2 ‘NHS providers and geographical regions’ in the 2019 Annual report to find the provider code of your NHS trust Magnify this slide to a minimum of 200% to allow you to identify the provider code of your NHS Trust on the ‘y-axis (vertical)’ Move the blue arrow to indicate where your trust lies on this graph To delete the yellow star marker and text before your presentation, click on the items and press the `backspace’ key on your keyboard If you require more exact local data values: Download the NHS organisation data viewer for the 2019 Annual Report from the website: https://www.nabcop.org.uk/content/uploads/2019/05/NABCOP_Annual_Report_2019_NHS_Organisation_Data_Viewer_LIVE.xlsx On the ‘CONTENTS’ page, select your NHS organisation in the drop down option in ‘Click in the cell below to scroll & pick the NHS organisation you want to be highlighted in the subsequent tabs:’ Go to the sheet `Chp7_M1_CT’ – and your trust will be highlighted @NABCOP_news

What do patients say about their BC care? - Cancer patient experience survey (CPES)* * Results available for women diagnosed in 2015 CNS involvement 95% were given the name of a CNS who would support them through treatment 78% said that it had been ‘quite’ or ‘very’ easy to contact their CNS DCIS 81% of respondents with ≥1 treatment options, reported that their options were explained to them completely Among women who had RT: 60% completely agreed that they were given enough information that their treatment was working (58% in 50-69 years, 77% in 70+ years) EIBC : on a scale of 0 (very poor) to 10 (very good), 96% of respondents gave their overall care a rating of ≥ 7 Among women who did not have surgery: this care rating was recorded in 96% of women aged 50–69 years and 88% of women aged 70+ years. Among women who had radiotherapy: 53% completely agreed that they were given enough information that their treatment was working Among women who had chemotherapy: 52% completely agreed that they were given enough information that their treatment was working The English Cancer Patient Experience Survey (CPES) in 2015 is the first year of CPES that can be linked to the NABCOP English patient-level dataset. It comprises a series of questions with multiple response options, in line with other patient surveys. The 2015 CPES survey was on patients discharged between 01/04/2015 and 30/06/2015. During this period, the survey was completed by 66% of patients with a confirmed primary diagnosis of cancer, discharged from an English NHS Trust after an inpatient episode or day case attendance for cancer related treatment. More information on CPES can be found at: http://www.ncpes.co.uk/reports/2015-reports/national-reports/2489-cpes-2015-national-report-pdf/file For more information on use of CPES in NABCOP, see section 2 ‘Audit methods’ in the NABCOP 2019 Annual Report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/ *** NOTE: this slide is designed as a guidance. See the boxes on ‘What do NABCOP patients, tell us in the English 2015 CPES’ in section 5-8 to adapt/condense this slide or for more information NABCOP recommendations: NHS organisations must ensure that women are given enough information about their radiotherapy or chemotherapy treatments. Clinical teams should ask for feedback from their patients, at regular intervals, to ensure that they have sufficient information.

Proposal: NABCOP fitness assessment To identify frailty, cognitive impairment and evaluate a patient’s overall health To be able to record the results of these assessments in a reproducible manner This is valuable towards ensuring women are not treated based on chronological age alone, and for improving methods of comparison of provision of care for older patients. One of the main recommendations of the 2019 Annual report is that older women should be counselled on breast cancer treatments (e.g. surgery, radiotherapy, chemotherapy) based on tumour characteristics and patient fitness, rather than chronological age alone. However, there is inconsistency in the assessment and recording of patient fitness in breast clinics in England and Wales (see organisational survey results from the 2017 NABCOP annual report: https://www.nabcop.org.uk/reports/nabcop-2017-annual-report/ ) NABCOP have designed a fitness assessment form to be used in breast clinics. This was piloted in 2018, and the findings of this can be found in section 9 ‘Fitness assessment form for older women in breast clinic’ in the 2019 NABCOP annual report: https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/

Abbreviated Mental Test Score Fitness assessment for older patients in breast clinic Majority of the pilot sites found the assessment useful towards decision making/ treatment planning. Abbreviated Mental Test Score 1. What is your age? 2. What is the time to the nearest hour? 3. Give the patient an address, ask him/her to repeat it at the end of the test e.g. 42, West Street 4. What is the year? 5. What is the name of the hospital/ number of residence where the patient is situated? 6. Can the patient recognise two persons (e.g. the doctor, nurse etc)? 7. What is your date of birth? (day and month sufficient) 8. In what year did World War 1 begin? 9. Name the present monarch/prime minister/president 10. Count backwards from 20 to 1 For more information on the this fitness assessment form, please refer to: https://www.nabcop.org.uk/resources/fitness-assessment-tool/ Do you have any severe* cardiorespiratory disease? Yes / No * severe = less than ordinary physical activity or rest causes tiredness, palpitations or shortness of breath Do you have any other significant malignancy? Yes / No

Local summary of NABCOP data Our data completion for core NABCOP data items : In comparison to the national average, our rate of: Surgery for DCIS is higher / lower / comparable (delete as appropriate) Surgery for ER-positive EIBC is higher / lower / comparable (delete as appropriate) Radiotherapy post-BCS for EIBC is higher / lower / comparable (delete as appropriate) Chemotherapy + trastuzumab for women with HER2-positive EIBC is higher / lower / comparable (delete as appropriate) 50-69 years 70+ years Tumour size % N-stage M-stage ER-status HER-2 status WHO performance status Instructions: Refer to slide 8 for key point 1 Refer to slide 11 for key point 2(i) Refer to slide 12 for key point 2(ii) Refer to slide 14 for key point 2(iii) Refer to slide 17 for key point 2(iv) @NABCOP_news

Local plan of action for NABCOP To improve data completion: [insert plan] To audit reasons behind variation for [insert type of treatment of interest] in women with [insert breast cancer group] Plan for re-audit: Time frame: [ insert ] Methods: [ insert ] Aim: [ insert ] Responsible consultant: [ insert name ] Please complete your local plan of action for NABCOP @NABCOP_news

w: www.nabcop.org.uk e: nabcop@rcseng.ac.uk : @NABCOP_news