OCIU is delivered by Solutions for Public Health Confidential & Proprietary, Copyright 2012, Solutions for Public Health Systemic Anti-Cancer Therapy Chemotherapy Intelligence Unit (CIU) Oxford

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Background The national collection of all cancer chemotherapy information in the NHS in England commenced on 1st April This is in line with the requirements of the Department of Health’s policy document Improving Outcomes: A Strategy for Cancer January The Systemic Anti-Cancer Therapy (SACT) Information Standard: – applies to all organisations providing cancer chemotherapy services in or funded by the NHS in England –relates to all cancer patients, both adult AND paediatric, in acute inpatient, daycase outpatient settings and delivery in the community; –Covers chemotherapy treatment for all solid and haematological malignancies, including those in clinical trials;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, SACT Data Set The dataset consists of 6 sections: –Section 1: Demographics & Consultant –Section 2: Clinical Status –Section 3: Programme & Regimen –Section 4: Cycle –Section 5: Drug Details –Section 6: Outcome

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Your CIU Contacts NamePosition Telephone Number Kellie PetersProgramme Lead / Trainer Regina LallyOperation Lead / Trainer Paul BuckleProject Marcia BennettProject Heather DaviesData Manager (Helpdesk) Wayne BrownData Manager (Helpdesk) Jacqueline HowesData Manager (Helpdesk)

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 1: Demographic & Consultant Data ItemCommentary  NHS NumberPrimary identifier, essential for data linkage {BLANK} Date of BirthSecondary identifier, and allows for analysis of provision by age {BLANK} Gender – CurrentTo allow analysis by Gender13 EthnicityTo allow analysis by ONS categories CQ Patient PostcodeTo allow analysis of geographical patterns of care HA1 1AA{BLANK} Data items highlighted in bold are mandatory This is the format required, as detailed in the SACT Data Set User Guidance v.9 published in September If your extract does not include data on a mandatory field, the record will be produce an error message at the point of validation.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 1: Demographic & Consultant (2) Data ItemCommentary  Registered GP Practice Code This allows reporting of commissioning X00008X Consultant GMC Code This allows identification of consultant team and patterns of management D X Consultant Speciality Code This allows analysis by speciality 146X01 Organisational Code of Provider This is the code of the provider initiating the programme of chemotherapy SPH00{BLANK} In many cases the Demographic & Consultant data items can be imported into the system used to report SACT from the hospital PAS interface If you report the Trust 3-digit code, all your reports will be produced at a Trust- level.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 2: Clinical Status Data ItemCommentary  Primary DiagnosisICD10: to allow analysis by tumour site C348{BLANK} MorphologyICD03: is essential for some tumour sites e.g. Haematology & Lung where ICD10 is inadequate 82633{BLANK} Stage of DiseaseTo allow analysis by stage, which is essential for outcome analysis For SACT, this is the PRIMARY DIAGNOSIS at the start of the Systemic Anti-Cancer Therapy. This is the PATIENT DIAGNOSIS for the cell type of the malignant disease recorded as part of a Cancer Care Spell.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 3: Programme & Regimen Data ItemCommentary  Programme IDTo allow for sequential analysis of patient care, may start at any number to accommodate previous treatment and is unique to each patient Regimen NumberTo allow for sequential analysis of patient care, may start at any number to accommodate previous treatment and is unique to each patient Intent of TreatmentTo allow analysis by treatment intent CX The national codes A Adjuvant N Neo-adjuvant C Curative P Palliative

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 3: Programme & Regimen (2) Data ItemCommentary  RegimenTo be consistent with the National Regimen List GEMCARBO Days 1+8{BLANK} The National Regimen List (OPCS 4.6) is available for download from the TRUD website. Hospitals are expected to map local/network regimen names to OPCS 4.6 for the purposes of Payment by Results, which came into affect on 1 st April The regimen name reported to SACT should be the ‘Dataset Short Version’, which is 35 characters. Where a regimen cannot be mapped, as it is waiting to be added to the list please send your local/network regimen name.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Potential upload content

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Current OPCS regimens Should be sent as 35 character OPCS Regimen Name (Dataset short version) These are mapped to SACT analysis groupings

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Pending OPCS regimens Pending list will be added to next release of OPCS list but should be available to us in draft form in the Autumn In the meantime CIU will hold a temporary list of known new regimens (i.e. ones seen in downloads) mapped to SACT groupings

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Examples of Regimen names that are awaiting to be added to the next iteration of the OPCS list, that have been submitted from contributing providers in April 2012

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Trial regimens This may not exactly match the ‘clinical trial’ field [SACT data item 23] It contains trial names which give no indication of the content and are not listed in OPCS regimens

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Examples of Trial Regimen names that have been submitted from contributing providers in April 2012.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Local regimens that don’t map These will be sent as the regimen local name, preferably as the drug approved name/s in alphabetical order; These local regimens will need to be mapped manually to SACT analysis groupings; Frequently occurring regimens will be added to the temporary list;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Other required SACT drugs/regimens These mostly have a direct anti-cancer effect but will not be on the OPCS Regimen list; These will ultimately be on an additional national list; Many of these have already been identified and mapped to SACT analysis groupings;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Supportive drugs/other These are drugs including anti-sickness drugs, steroids and antibiotics which are not currently required for analysis but some may be added in the future;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Trust regimens OPCS name list +”other” PbR procurement and delivery codes for commissioning OPCS short name for dataset Trials not in OPCS list Other regimens that do not map to OPCS SACT regimen group for analysis SACT Trial group for analysis Matches SACT group in temporary list* No match to any of the above Amalgamate for analysis Manual grouping for analysis “Trial” in analysis (mapped) CIU Processing of uploaded regimens NOT CHEMO Other records ( anti-sickness etc.) * temporary list will contain regimens destined for OPCS and those that will be commissioned via the hormones/supportive list (not currently mapped by trust)

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 3: Programme & Regimen (3) Data ItemCommentary  Height at Start of Regimen To allow comparison of dose by metre Weight at Start of Regimen To allow comparison of dose by metre Performance Status at Start of Regimen WHO or Lansky – to allow case mix adjusted analysis 2101 Co-morbidity adjustment Yes/No - to allow case mix adjusted analysis YX Date decision to Treat To allow analysis of wait before treatment start May 2011 Start Date of Regimen To allow analysis by time period {BLANK} 0 in both the WHO and Lansky is a valid value – please check that your system is not defaulting to ‘0’

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 3: Programme & Regimen (4) Data ItemCommentary  Clinical TrialYes/No – to identify chemotherapy given within clinical trials NX Chemo-RadiationYes/No – to identify use of chemo-radiation, only used in recognised treatment regimen YX Number of Planned Cycles To allow comparison with number of cycles actually given. Not necessary relevant for palliative treatment 40

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 4: Cycle Data ItemCommentary  Cycle NumberSequential within each regimen and indicates the patients progress through the regimen. 6XX Start Date of CycleThe date of the first administration in each cycle Jan 2012 Weight at Start of Cycle Where relevant to allow for dose reduction Performance Status at Start of Cycle To assess patient’s suitability for further treatment OPCS Procurement Code X719XXXX Weight at Start of Cycle is the only optional data item within SACT. All other data items are expected to be reported to the Chemotherapy Intelligence Unit in Oxford.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 4: Cycle (2) Data ItemCommentary  OPCS Procurement Code X711XXXX

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 5: Drug Details Data ItemCommentary  Drug NameThis is the approved name in the BNF, it identifies individual drug usage GemcitabineX OPCS Delivery Code X722X000

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 5: Drug Details (2) Data ItemCommentary  Actual Dose Per Administration For oral regimens this is the daily dose. Allows calculation of cumulative dose per patient and global drug usage. 120XXX Administration Route To allow analysis by route of administration 0422 Administration DateThe date of actual administration Jan 2012 Organisational Code of Provider This may change throughout the regimen. To Allow analysis by provider. SPH00XX999 Two common issues with date fields: records with a date out of sequence i.e. Administration Date is before Regimen Start Date Default date 01/01/1900 being reported

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Section 6: Outcome Data ItemCommentary  Date of Final CycleDate of Start of Final Treatment Jan 2012 Regimen Modification – Dose Reduction Yes/No – Where a dose of any SACT drug is reduced at any cycle NX Regimen Modification – Time Delay Yes/No – Where administration of drugs is delayed > 5 days at any cycle NX Regimen Modification – Stopped Early Yes/No – Where the regimen is abandoned before the planned number of cycles NX Regimen Outcome Summary To record the immediate outcome of the treatment Patient ChoiceX Date of DeathTo estimate 30-day mortality Feb 2012 As the Chemotherapy Intelligence Unit is hosted within a Cancer Registry they will receive Date of Death details as part of the Office of National Statistics ‘Cancer Deaths’ and ‘Non Cancer Deaths’ which they will use to append to the patient record.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Where are you on the implementation of SACT?

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, State of Readiness Questions How many of the 42 SACT data items will you be reporting? –If you are using a e-Prescribing system, the expectation is that all 42 data items will be submitted; –It is worth noting that there is only one optional field in the dataset, all other fields are either Mandatory or Required; Will your SACT extract include: –All solid tumours If no, which tumour groups will you be reporting When will you report all solid tumours? –Haematology If no, when will this be achievable? –Paediatrics If no, when will this be achievable?

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Your SACT CSV Data File Please note that this is demo data

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Your SACT CSV Data File (2) Extract criteria for upload, where a patient has: A date decision to treat in the month (Data item 21) A start date of regimen in the month (Data item 22) A start date of cycle in the month (data item 27) A administration date (data item 35) A Date of final treatment (Data item 37) A date of death (data item 42)

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Notes: You have to be a registered user to access the SACT Portal; When registering you will be asked what permission you require: Upload Data Provider Approver; or Network You can only access the Portal via the NHS N3!

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, State of Readiness Questions (3) Roles & Responsibilities –Who, in your hospital will be responsible for uploading the SACT data on a monthly basis? –Who, in your hospital will be responsible for approving the chemotherapy activity? –Who is the Cancer Network will require access to SACT compliance information?

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Only users with ‘Upload Data’ permission will see information in this box. If this is your first month of submission, there will be ‘no files are waiting for submission’

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, The CIU Helpdesk will update this section each month with relevant information. The CIU team has developed a video that will talk you through how to upload your SACT file to the Upload Portal. Note: You will need Abode Flash Player to run the video You have the ability to filter on the file status.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, You can also access the video on how to upload your monthly SACT file here.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Once your monthly file is validated it will display a report on the quality of the data contained in your extract

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH,

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, The minimum threshold is 80% of mandatory fields must be partially valid. Aim for 100% 1. Submit button will not be available until you meet 80% minimum threshold; 2. Remember to submit between 1 st and 15 th of each month!

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, In order to get Patient Count you must submit: Admin Date Drug Name In order to get Cycle Starts you must submit Cycle Start Date 1.SACT data awaiting provider approval is available from 16 th to end of month. 2.You must be registered with provider approval to view

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, This is the ‘provider approvers’ opportunity to provide commentary on the current month’s activity. These notes will be viewed by the analysis team at the CIU.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, State of Readiness Questions (4) Do you wish to test your SACT data file? –Please review the Frequently Asked Questions, as these have been generated during the testing phase.Frequently Asked Questions Have you started work on mapping your local Regimen names to the OPCS 4.6 list that was published in February 2012? –The list can be downloaded from the TRUD website; Training materials are available on the CIU upload portal and the CIU website. Register with

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, The CIU has developed a Supplier Test Version of the upload portal This allows Software Suppliers to test their SACT extracts to ensure they are compliant with the ISB Standard;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, When to Submit SACT Data?

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Monitoring SACT Conformance Monitoring which Trusts have submitted and approved SACT data; 80% minimum quality threshold for mandatory items in force; Planned implementation of monthly SACT Data Completeness report. –Sent to all Cancer Networks –Sent to all Trusts

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Monitoring SACT Conformance Data completeness reports will be produced by: Trust Cancer Network* *will be sent out by NCAT & NCIN You will only appear on this report once you have approved your monthly submission;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, SACT Analysis - What to Expect... As soon as sufficient data have been quality assured and analysed, initial reports will be issued to contributing providers. Once established, this will be a continuing process and will require careful governance and maintenance; Benefits –Valuable for those providing and commissioning chemotherapy services; –It will support patients and their clinical teams in choosing appropriate care, based on accurate knowledge of current practice and the corresponding benefits and toxicities of treatment;

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, “Sense check” completed by next submission April 1st Monthly submissions >>>>>> Analysis sequence - monthly Technical data quality feedback (by return) Diagnostic group Regimen starts Cycle starts Breast30200 Lower GI25180 Gynae2560 Lung1680 Lymphoma28230 Urology1256 etc

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Global analysis – all submitting trusts Top 10 regimens by diagnostic group – regimen and cycle starts % of total patients by diagnostic group “Sense check” completed by next submission April 1st Monthly submissions >>>>>> Analysis sequence – 3 monthly

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Global analysis – all submitting trusts Top 10 regimens by diagnostic group – regimen and cycle starts % of total patients by diagnostic group “Sense check” completed by next submission April 1st Monthly submissions >>>>>> Analysis sequence – 3 monthly Top 10 regimens by diagnostic group – regimen and cycle starts % of total patients by diagnostic group Individual trust analysis – all submitting trusts +

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Patients treated by diagnostic group Once contributing providers have submitted and approved 3 consecutive months of SACT activity they will receive both a global view and a trust view of ‘Patients treated by diagnostic group’

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, The ‘top 10 regimens by diagnostic group’ will be available to contributing providers who have submitted and approved 3 consecutive months of SACT activity. They will have the opportunity to compare their Trust view with that of the global perspective.

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, “Sense check”completed by next submission April 1st Monthly submissions >>>>>> Analysis sequence – 6 monthly

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Comparative trust analysis cycle starts by diagnostic grouping ( - by PbR peer group or network )

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, Analysis sequence – annually Global analysis – all submitting trusts Individual trust analysis – all submitting trusts Comparative trust analysis – all submitting trusts + Age profile of treated patients + Geographical mapping of activity April 1st

OCIU is delivered by Solutions for Public Health (SPH). © Copyright SPH, QUESTIONS...?