1. National
Oesophago–Gastric Cancer
Audit 2015

2. This slide set is designed to
Summarise the main audit findings for presentation at local MDT meetings
Help you to audit your local trust practice against other Trusts in your SCN and against National figures where appropriate.
We have designed the slides so that you can enter your data from the Annexes of the Annual Report in the appropriate space.

3. High Grade Dysplasia (HGD) of the Oesophagus
Since April 2012, the NOGCA has been collecting data on patients with HGD of the oesophagus
The audit aims to monitor current practice against national guidelines
The key BSG recommendations are:
Diagnosis should be confirmed by a second GI pathologist
Patients should be discussed at a specialist MDT
Endoscopic treatment preferred over surgery or surveillance
EMRs should be performed in high volume centre
Fitzgerald RC et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7-42.  

4. National figures for HGD
930 cases submitted to NOGCA
Diagnosed between 1st April 2012 and 31st March 2014
Source of referral
51.1% Symptomatic
40.4% Barrett’s surveillance
8.5% Unknown
82.8% Diagnosis confirmed by 2nd pathologist
87.3% Cases discussed at specialist MDT

5. National figures for HGD
Currently, 35.8% of cases referred on to specialist hospital for treatment
Number of cases treated is low at many hospitals
Majority treated <5 cases over 2 years
Only 7 treated ≥30 cases over 2 years

6. Treatment Plan for HGD
BSG recommendation: Endoscopic treatment preferred over surgery or surveillance
Proportion managed by surveillance associated with
Age at diagnosis
12.6% <60 yrs compared to 43.2% ≥80 yrs (p<0.001)
Hospital where treated
Low-volume hospital 33.1% vs high-volume hospital 14.9% (p<0.001)

7. Treatment Plan for HGD
Proportion managed by surveillance varied by SCN

8. Local HGD Data submissions
XXX cases of HGD submitted to NOGCA between 1st April 2012 and 31st March 2014
Completeness of HGD records submitted.
Including the use of ‘unknown’ for mandatory variables.
Variable type
Variable Name
Local Trust
Mandatory
(% with ‘not known’ or ‘NA’ recorded
Source of referral (%)
xxx
Diagnosis confirmed by a second pathologist
Non-Mandatory
(% complete)
Length of circumferential Barrett’s
Treatment agreed at MDT
Complete this slide using data from Annex 5 of 2015 Annual Report, p58.
NB Trusts who submitted data on less than 10 cases of HGD are not included in this Annex.

9. Management of HGD in local SCN
National
SCN
Cases recorded
930 xx
Diagnosis
% Diagnosis confirmed by 2nd pathologist
82.8%
Management
% Discussed at MDT
83.7%
% Active Management
83.8%
Complete this slide using data from Annex 6 of 2015 AR, p59.

10. Key National Findings for HGD
Good adherence to recommendation that diagnosis confirmed by second pathologist and cases discussed at MDT.
But HIGH proportion of cases still managed by surveillance alone
NHS Trusts and Health Boards should consider referral of patients with HGD to a specialist centre for treatment where local expertise not available.
Add slide for any key local findings

11. Oesophago-gastric (OG) Cancer
Audit prospectively collected data on:
Patients diagnosed with invasive epithelial OG cancer
Diagnosed in NHS hospitals in England or Wales
Aged over 18 at diagnosis
Data submitted of 22,301 patients
Diagnosed between 1st April 2012 & 31st March 2014
Estimated case ascertainment = 80%

12. Local OG cancer Data Submissions
National
Local Trust
OG cancer
Cases recorded
22,301 xx
% case ascertainment
79.8%
Complete this slide using data from Annex 3 of 2015 AR, p52.
NB Trusts who submitted data on less than 10 cases of HGD are not included in this Annex.

13. Completeness of surgical records
It is important that key variables are submitted
NOGCA reviewed the completeness of surgical records submitted to the audit.
Including the use of ‘unknown’ for mandatory variables.
Local Trust
Number of surgical cases
Xxx
Surgical intent recorded (%)
Complications recorded (%)
Death in hospital recorded (%)
Matched pathology record (%)
xxx
Complete this slide using data from Annex 4 of 2015 AR, p56.
NB Trusts who submitted data on less than 10 cases of HGD are not included in this Annex.

14. Completeness of Pathology records
Staging data is key data for risk adjusting cases when monitoring surgical outcomes
Audit assessed the proportion of cases with complete pathological TNM stage.
Local Trust
T-stage recorded (%)
Xxx
N-stage recorded (%)
M-stage recorded (%)
xxx
Complete this slide using data from Annex 4 of 2015 AR, p56.
NB Trusts who submitted data on less than 10 cases of HGD are not included in this Annex.

15. Treatment Plan for OG cancer
Overall proportion of patients treated with curative intent was 38.1%

16. Surgery
A total of 4,951 curative surgical records were submitted
3,036 Oeosphagectomies
1,701 Gastrectomies
Increased use of multimodal therapy (e.g. neoadjuvant chemotherapy) since 2010
Increase in proportion of minimally invasive (MI) operations.
Oesophagectomies: 41% MI or Hybrid (30% in 2010)
Gastrectomies: 14% MI (13% in 2010)

17. Surgical Outcomes
Oesophagectomy (%)
Gastrectomy (%)
2010
2015
30-Day mortality
3.8
2.2
4.5
2.3
90-Day mortality
5.7
4.3
6.9
4.2
Complication rate
29.8
36.9
19.4
23.7
Fall in both 30 and 90 day postoperative for curative oesophagectomy and gastrectomy.
Overall complication rates remain high
Increased rate since 2010 probably reflects better reporting of complications to the NOGCA

18. Surgical Outcomes National Local Trust Curative surgery volume 4,951xx
Mortality rate
30-day
90-day
Complication rate
On this slide you can compare your trusts mortality to national figures and highlight your own trust on the graph

19. Oesophageal SCCs Curative treatment options
Upper oesophageal SCCs: Definitive oncology preferred
Mid/lower oesophageal: Definitive oncology or surgery may be considered.
Current management in England and Wales
67% upper oesophageal lesions received definitive oncology
Mid/ Lower oesophageal more even split: 46% definitive oncology and 54% surgery.

20. Mid/Lower Oesophageal SCCs
Significant variation across SCNs in choice of curative treatment for SCCs (surgery vs definitive oncology)
On this slide you can highlight choice of tx in your SCN

21. Definitive Oncology
English radiotherapy data (RTDS) linked to NOGCA for patients diagnosed April 2012 to March 2013
Treatment regimen aligned with Royal College of Radiologists recommendations for:
65% patients treated with definitive chemoradiotherapy for oesophageal cancer.
49% patients treated with definitive radiotherapy alone for oesophageal cancer.
RTDS dataset will allow further exploration of use of radiotherapy in future.

22. Palliative Treatment for OG cancer
Two thirds of patients managed palliatively
Palliative oncology most common treatment
Completion of palliative chemo is low (54.9%)
Endoscopic / radiological stent insertion used to treat dysphagia in many patients
Combining data from Audit and HES suggests
3,357 patients with oesophageal cancer had a stent inserted
BUT only 59.5% of patients who had stent insertion recorded in HES had record submitted to audit.

23. Place of Death
The Audit investigated place of death among patients with a palliative treatment intent.
Proportion of patients dying in hospital significantly higher in patients living in most deprived areas compared to least deprived (39% vs 30%).
Place of Death
Number of patients %
Care Home
1,310
10.9
Home
4,110
34.3
Hospice
2,223
18.5
Hospital
4,150
34.6
Other
208
1.7

24. Recommendations for OG cancers
NHS trusts should closely monitoring the complication rates among curative surgical patients
All patients with oesophageal SCCs being considered for curative therapy should be discussed with a surgeon and oncologist
Completion rates for palliative chemotherapy remain low, and patients need to be assessed carefully before starting treatment
Trusts need to review their policies for ensuring patients who have a palliative stent inserted have this data submitted to the audit.

25. Contact Details For any queries please contact: Dr Georgina Chadwick
Clinical Research Fellow
The National Oesophago-Gastric Cancer Audit