Variations in Cancer Surgery Across the East Midlands and North Trent EMPHIN Forum (Apr 2010) Carolynn Gildea Trent Cancer Registry

Methods Breast (female) and Lung cancer diagnosed patients HES inpatient/day case linked to Registry Surgery 6 months following diagnosis Stage, PCT, Deprivation, Age, Ethnicity, Gender, Morphology

Breast Cancer - Summary  71% of tumours receive relevant surgery  40% of tumours receive mastectomy, 33% conserving surgery  30% of tumours receive block dissection of lymph nodes, 34% sampling of lymph nodes

Breast Cancer - By PCT  Within the East Midlands, any relevant surgery varies from 61% (Lincolnshire) to 77% (Leicestershire County and Rutland)

Breast Cancer - By Stage  85%-90% of stage 1-3 tumours receive surgery  only 28% of stage 4 tumours receive surgery

Breast Cancer - By Deprivation  Mastectomy and block dissection of lymph nodes are more common for residents of more deprived areas  Conserving surgery and sampling of lymph nodes are less common for residents of more deprived areas

Breast Cancer - By Age  Elderly patients are less likely to receive all types of surgery  Only 17% of patients aged 85+ receive surgery, compared to around 80% of patients under 70  Conserving surgery is most common for patients aged 50-70

Lung Cancer - By PCT  8.5% of tumours receive relevant surgery  In the East Midlands, relevant surgery varies from 7.3% (Lincolnshire) to 11.5% (Leicester City)

Lung Cancer - By Deprivation  Patients from more deprived areas are less likely to receive relevant surgery

Lung Cancer - By Age  Elderly patients are less likely to receive relevant surgery  Only 0.6% of patients over 85 receive relevant surgery, compared to 46.9% of patients under 35

Next Steps Engage with clinicians Include extra 2008/09 HES data Investigate radiotherapy and chemotherapy Include stage for Lung cancer Include Charlson morbidity National analyses by NCIN