1. Information Projects TeamThyroid Cancer March 2001 Taxanes for Ovarian Cancer: Progress Report Rosemary Tate Projects Co-ordinator January 2001

2. Information Projects TeamThyroid Cancer March 2001 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

3. Information Projects TeamThyroid Cancer March 2001 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

4. Information Projects TeamThyroid Cancer March 2001 Data Required Complete regional coverage Diagnosis Patient-based Chemotherapeutic agents prescribed Chemotherapeutic line (1st, 2nd, 3rd) Clinical trial, name, arm

5. Information Projects TeamThyroid Cancer March 2001 Data Sources Investigated Registry data Regional Pharmacists –Medicare Audit UK database Northern Gynaecological Oncology Group (NGOG) database Clinicians’ own data Trust/hospital Pharmacy data

6. Information Projects TeamThyroid Cancer March 2001 Registry Ovarian Cancer Data (September 2000, excluding certain paths., private & ER hospitals)) N.B. Chemotherapeutic agents, trials and line data not recorded

7. Information Projects TeamThyroid Cancer March 2001 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

8. Information Projects TeamThyroid Cancer March 2001 MEDICARE AUDIT DATA Up to Feb 2000

9. Information Projects TeamThyroid Cancer March 2001 Medicare Data - Missing Trusts Airedale) Calderdale) Dewsbury) Newcastle-upon-Tyne Hospitals) do not North Durham) prescribe Northumbria) Taxanes? Priority Healthcare Wearside) Sunderland) Tees and North East Yorks) York) North East Lincs) not in our Scunthorpe and Goole) region?

10. Information Projects TeamThyroid Cancer March 2001 NGOG Database 16/27 Northern hospitals submit data 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

11. Information Projects TeamThyroid Cancer March 2001 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

12. Information Projects TeamThyroid Cancer March 2001 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

13. Information Projects TeamThyroid Cancer March 2001 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 variation in software used (Ascribe used by 3) –6 (33%) had paper and electronic records –1 (6%) had no records of taxane prescribing

14. Information Projects TeamThyroid Cancer March 2001 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

15. Information Projects TeamThyroid Cancer March 2001 Pharmacy Departments Prescribing Taxanes up to Sept/Oct 2000 PRESENT ON MEDICARE: Leeds General Infirmary St Jamess University Hospital (Leeds) Princess Royal (Hull) Huddersfield Royal Bradford Royal Cumberland Infirmary (Carlisle) Pinderfields General Queen Elizabeth (Gateshead) Hartlepool General Darlington Memorial South Cleveland Newcastle General Harrogate District NOT PRESENT ON MEDICARE:: Airedale General South Tyneside District Sunderland Royal Scunthorpe General Diana Princess of Wales (Grimsby)

16. Information Projects TeamThyroid Cancer March 2001 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%)

17. Information Projects TeamThyroid Cancer March 2001

18. Information Projects TeamThyroid Cancer March 2001 Plans for the Main Study Ask Steering Group for names of prescribing clinicians Simultaneously ask pharmacies to complete a q’naire re prescribing information Download data from registry for all of 2000 (repeat downloads) Match information and send postal q’naire to clinicians on Taxane use Casenote validation (all/sample?)