1. Northern Oesophago-Gastric Cancer Unit MDT meeting NECN Audit day 2012 Helen Jaretzke, Angie Tate, Jon Shenfine, Paula Brookes, Leigh-Anne Phillips, Gillian Robinson, Jonathan Stoddart

2. Methods Patients discussed at Friday Newcastle Multi-disciplinary Team meeting (MDT) –January 2011 – December 2011 Excludes: Patients discussed by video-link to Sunderland only Prospective data entry onto database - Dendrite Intended use: –Local, Regional & National audit –Research Data then exported onto Microsoft Excel for analysis

3. National Audit: Recommendations

4. Units Contributing to NOGCANumber of Patients Lancashire and South Cumbria 458 Greater Manchester and Cheshire 1,044 Merseyside and Cheshire 681 Yorkshire 424 Humber and Yorkshire Coast 169 North Trent 706 Pan Birmingham 360 Arden 237 Mid Trent 724 Derby/Burton 286 Leics, Northants and Rutland 577 Mount Vernon 232 West London 289 North London 88 North East London 476 South East London 265 South West London 227 Peninsula 636 Dorset 267 Avon, Somerset and Wiltshire 448 3 Counties 534 Thames Valley 487 Central South Coast 684 Surrey, West Sussex and Hampshire 211 Sussex 310 Kent and Medway 430 Greater West Midlands 505 North of England 1,252 Anglia 896 Essex 199

5. Units Contributing to NOGCA Number of Patients Lancashire and South Cumbria 458 Greater Manchester and Cheshire 1,044 Merseyside and Cheshire 681 Yorkshire 424 Humber and Yorkshire Coast 169 North Trent 706 Pan Birmingham 360 Arden 237 Mid Trent 724 Derby/Burton 286 Leics, Northants and Rutland 577 Mount Vernon 232 West London 289 North London 88 North East London 476 South East London 265 South West London 227 Peninsula 636 Dorset 267 Avon, Somerset and Wiltshire 448 3 Counties 534 Thames Valley 487 Central South Coast 684 Surrey, West Sussex and Hampshire 211 Sussex 310 Kent and Medway 430 Greater West Midlands 505 North of England 1,252 Anglia 896 Essex 199

6. North of England County Durham and Darlington NHS Foundation Trust North Cumbria Acute Hospitals NHS Trust North Tees and Hartlepool NHS Trust Northumbria Healthcare NHS Foundation Trust South Tees Hospitals NHS Foundation Trust The Newcastle upon Tyne Hospitals NHS Foundation Trust

7. Discussions: Central Newcastle MDT n=1444 incl Carlisle - 87 510 excl Carlisle

8. New discussions n=597 + ca 522 Other incl. – Gists, HGD, LGD, Surveillance pts, Barrett’s surveillance pts, referred onto another MDT

9. New OG neoplasm n=437

10. Number of New MDT Discussions N=437 Excl. Carlisle pts

11. Comparison 2008-2011 multiple discussions Excl. Carlisle pts

12. Carlisle Discussions

13. New referrals to MDT by site n=450 vs. 324 vs. 408 vs 467 vs 437 2011 – excl Carlisle pts – positive cancers only

14. Intention to treat by site - 2011 No action – incl. Best supportive care & referral onto other MDT’s Friday MDT’s only

15. Oesophageal Cancer: (2011) Histological subtype Other incl. – Carcinoid, Leioyoma

16. Oesophageal Cancer: Treatment intent by histological subtype

17. Oesophageal cancer: Curative treatment intent

18. Resections

19. Resections breakdown - 2011

20. Morbidity n=136 - 2008 n=137 - 2009 n=149 - 2010 n=162 - 2011

21. Mortality – surgery 2011 Please note: above figs are actual. Open and close are not included

22. Pathological Stage by subtype Excl. Carcinoid’s & Leioyoma’s excluded, 8 open and close excluded

23. Oesophageal Cancer: Treatment change Intended TreatmentTreatment Changen Neoadjuvant + SurgeryUnfit for surgery1 Neoadjuvant + SurgeryProgression of disease, no surgery4 Neoadjuvant + SurgeryRIP (1 cycle)0 Neoadjuvant + SurgeryMoved to clinical trial0 Neoadjuvant + SurgeryShortened chemotherapy due to toxicity5 Magic + surgeryNo post-op chemo given due to chest pain0 Neoadjuvant + SurgeryLow GFR, no neoadjuvant given2 Neoadjuvant + SurgeryPatient declined1 SurgeryNot fit for surgery/patient declined2 ChemoradiotherapyNot fit for CRT1

24. Recruitment to trials - 2011

25. UGI Two Week Waits 2011

26. 2 Week Waits - Comparison

27. Breaches - Comparison

28. Issues? Re-haul of database –Now gives us what we need –Much more accurate Complications data much improved –Now introduced Clavien-Dindo/Accordian –Robust weekly system for collection of data on complications

29. Why complicate things…