1. Taxanes for Ovarian Cancer: Progress Report Rosemary Tate Information Projects Team December 2000

2. Background Issues Recent research evidence has shown improved survival times with paclitaxel (Taxol) for ovarian cancer patients High cost Variation in HA funding Yorks Network (Aug 98), Northern (May 99) National Cancer Guidance (July 99) NICE (May 00)

3. Aims and Objectives (1) To quantify proportion of patients with a newly diagnosed, histologically confirmed ovarian cancer who received chemotherapy in 1998 compared with 2000 To determine the proportion of patients who received taxane-based chemotherapy as first/second/third line chemotherapy

4. Aims and Objectives (2) To describe the patterns of yearly taxane prescribing across the different Health Authorities of N & Y To identify the circumstances under which taxanes were given, e.g. in a cancer centre/unit, as part of a trial/protocol To investigate reasons for any variation in the use of taxanes

5. Data Required Complete regional coverage Diagnosis Patient-based Chemotherapeutic agents prescribed Chemotherapeutic line (1st, 2nd, 3rd) Clinical trial, name, arm

6. Data Sources Investigated Registry data Regional Pharmacy –Medicare Audit UK database Northern Gynaecological Oncology Group (NGOG) database Clinician’s own data Trust/hospital Pharmacy data

7. Registry Ovarian Cancer Data (September 2000, excluding certain paths., private & ER hospitals)) N.B. Chemotherapeutic agents, trials and line data not recorded

8. Medicare Audit Data 95% UK coverage of overall prescribing patterns Covers several high-cost drugs, listed by specialty, Trust May be made up at one hospital, but prescribed at another Trials and line data not recorded

9. MEDICARE AUDIT DATA

10. Medicare Data - Missing Trusts Airedale) Calderdale) Dewsbury) Newcastle upon Tyne Hospitals) do not North Durham) prescribe North Lakeland) taxanes? Northumbria) Priority Healthcare Wearside) Sunderland) Tees and North East Yorks) York) North East Lincs) not in our Scunthorpe and Goole) region?

11. NGOG Database 16 larger Northern hospitals submit data 11 smaller hospitals and NCCT have not Patient-based data from Jan 1997 Diagnostic, FIGO staging, Trials data included Chemotherapy type unreliably recorded Clinician compliance disappointing Changing to data entry at clinical interface

12. Clinicians’ patients receiving Taxol 1998-2000 List of 11 Northern clinicians’ named patients with dates prescribed and costs 30/53 patients identified on Registry database as having ovarian cancer diagnosis Cost per patient varied from £1,026 to £11,437 (Mean £5690, SD £2960) Administered for mean of 67 days and up to 121 days

13. Treatment pathway of patients receiving Taxol 1998-2000 as recorded by Registry 9/30 (30%) patients had surgery immediately after diagnosis 6/30 (20%) had chemotherapy 1 to 7 months after surgery 5/30 (17%) had Taxol 5 months to 3.5 years after first chemotherapy 1/30 (3%) had post-op radiotherapy 21/30 (70%) had no treatment

14. Clinicians’ patients receiving Taxol 1998-2000 Patients prescribed Taxol 7 months to 12.5 years after diagnosis, mean 3.5 years 12/30 (40%) who received Taxol 1998 - 2000 were diagnosed 1998 - 2000 1/30 (3%) chemotherapy date = Taxol date (7 months after diagnosis) 15/30 (50%) patients now dead, given Taxol in year preceding death

15. Trust/Hospital Pharmacy Data Held 30/31 (97%) Pharmacies returned completed questionnaires 18/30 (60%) reported that they prescribed taxanes 1998 - 2000 –8 (44%) had paper records only –3 (17%) had electronic records only –6 (33%) had paper and electronic records –1 (6%) had no records of taxane prescribing

16. Trust/Hospital Pharmacy Data Items (N = 18) 87% Patient name 76% Chemotherapy type 74% Clinician name 36% Trials details 31% NHS No 28% Patient diagnosis 20% Chemotherapy line no. 6% Clinical stage

17. Pharmacy Departmental Software

18. Pharmacy Department Comments (13/18 or 72%) missing information can be obtained from clinician involved (28%) could cross-reference with other data sources to cope with lack of diagnosis/staging info. but would involve “mammoth task of paper sorting” (22%) only one consultant prescribes taxanes for ovarian cancer in our hospital (17%)

19. Pharmacy Department Comments (continued) patients receiving taxanes referred to Cancer Centre (6%) “patient numbers very small” (6%) “regional database on treatment would be helpful” (6%) taxanes only used with small number of private patients (6%)

21. Further Possibilities Leeds/Yorkshire clinicians’ data Medical records –sampling 2 x 6 months’ of data? Change inclusion criteria to taxanes prescribed 1998 - 2000 rather than patients diagnosed 1998 - 2000 Prospective regional data collection of pharmacy data MUST be able to identify ALL patients who received taxanes in study sample