1. National Oesophago–Gastric Cancer Audit Comparing local and national figures

2.  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.

3. NationalLocal Trust OG cancer Cases recorded22,832xx % case ascertainment78.6%xx % NOGCA successfully linked with RTDS 90.6%xx HGD Oesophagus Cases recorded465xx Data submitted to NOGCA

4. Local Trust Number of surgical cases Surgical intent recorded (%) Complications recorded (%) Death in hospital recorded (%) Matched pathology record (%) 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.

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

6. Surgical Outcomes NationalLocal Trust Curative Surgery volume4,898xx Mortality rate 30-day2.4%xx 90-day4.4%xx Complication rate27.7%xx On this slide you can compare your trusts mortality to national figures and highlight your own trust on the graph DELETE THIS BOX

7.  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. Quality of surgery indicators NationalLocal 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

8.  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. Surgery with adjunct oncology  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. 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

9.  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. OG cancer in elderly 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

10.  5.4% OG cancers diagnosed at early stage (T0/1,N0,M0).  Across SCNs significant variation in proportion of cancers diagnosed early. Early Cancers 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

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