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Variations in care for head and neck cancer patients

26 July, 2013: There is a wide variation in the numbers of head and neck cancer patients receiving important elements of care, according to a national audit report released today.

*Accompanying regional information is available from this audit in the table below

The National Head and Neck Cancer Audit has examined how far England's 28 regional cancer networks are delivering the 'Ideal Patient Pathway' of seven key aspects of care to head and neck cancer surgical patients5.

The report has found a wide variation in the percentages receiving this ideal care from 0 per cent to 23.5 per cent6. Across the country, 3.1 per cent of patients were recorded as receiving the 'Ideal Patient Pathway', with the largest group (24.7 per cent) recorded as receiving three aspects7.

The Ideal Patient Pathway consists of seven elements of care, which when combined indicate that the patient received holistic and integrated care across the complex care needs of their head and neck cancer. These elements of care include having nutritional, speech and language, dental assessments and chest scans or x-rays before surgery, having the case discussed by a multi-disciplinary team which brings together:

at least three surgeons; drawn from the ENT, Oral & Maxillofacial Surgery or plastic surgery specialities,

  • 2 clinical oncologists;
  • histopathologist/cytopathologist;
  • radiologist;
  • clinical nurse specialist;
  • head and neck cancer ward member of nursing staff
  • speech and language therapist;
  • dietician;
  • MDT co-ordinator/secretary;

Across England as a whole some of the seven aspects of care tend to be delivered much more consistently than others. For instance, 96.4 per cent of all head and neck cancer patients have their case discussed by a multi-disciplinary team, but just 18.8 per cent have an assessment with a speech and language therapist before their surgery.

The findings are published today in the National Head and Neck Cancer Audit eighth Annual Report 2012, which was commissioned and sponsored by the Healthcare Quality Improvement Partnership, (HQIP) developed in partnership with British Association of Head and Neck Oncologists (BAHNO) and managed by the Health and Social Care Information Centre (HSCIC). Data was submitted by all head and neck cancer teams in England and Wales relating to the care of 8100 patients between 1 November 2011 and 31 October 2012.

The data also shows that there has been an improvement in proportion of head and neck cancer patients surviving. The number of patients surviving for a year from diagnosis has risen from 84.4 per cent in 2010 to 87.5 per cent in 2012. Care needs to be taken in attributing this to genuine improvements in the quality of delivered patient care, but it remains an encouraging trend to be explored in more detail in future reports.

Audit lead clinician Mr Richard Wight said: "We are delighted to report again the involvement of the head and community in actively contributing to audit, which forms a key part in promoting better care. The new focus on the Ideal Patient Pathway has been encouraged by patient representatives. This analysis supports continuing improvement and provides assurance to commissioners of head and neck cancer care."

Accompanying table for the release can be downloaded here: pdf icon Accompanying tables to head and neck cancer press release [338kb]

ENDS

           

Notes to editors

1. The Health and Social Care Information Centre (HSCIC) was established on 1 April 2013 as an Executive Non Departmental Public Body (ENDPB). The trusted source of authoritative data and information relating to health and care, HSCIC plays a fundamental role in driving better care, better services and better outcomes for patients. The HSCIC supports the delivery of IT infrastructure, information systems and standards to ensure information flows efficiently and securely across the health and social care system to improve patient outcomes. Its work includes publishing more than 130 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

2. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

3. The audit analysis was performed by the HSCIC and Public Health England, South East Knowledge and Intelligence Team (SEKIT) and the Welsh Cancer Intelligence and Surveillance Unit on data extracted from the Data for Head and Neck Oncologists (DAHNO) data collection database. The data extract period includes patient records with a date of diagnosis between 1 November 2011 and 31 October 2012. Data on 8099 patients was included in the audit, with 7726 cases from England and 546 cases from Wales.

4. The Ideal Patient Pathway consists of a variety of aspects of care, which when combined indicate that the patient received holistic and integrated care across the complex care needs of their head and neck cancer. All but the final aspect (Resective pathology discussed at MDT) are agreed national standards*:

  • Pre-treatment seen by clinical nurse specialist (CNS)
  • Pre-treatment nutritional assessment
  • Pre-treatment speech and language therapy (SALT) assessment
  • Pre-treatment dental assessment
  • Pre-treatment chest CT / CXR
  • Discussed at multidisciplinary team (MDT)
  • Resective pathology discussed at MDT

*The British Association of Head and Neck Oncologists, BAHNO Standards 2009 http://www.bahno.org.uk

For the first time the audit has looked at its data from the perspective of individual patients. How many of the seven key aspects of care surgical patients have received is published alongside the performance of cancer networks in delivering these aspects of care. The radar chart presents the percentage of surgical patients recorded as having resective pathology discussed at MDT, whereas the other six aspects are a percentage of all the cancer patients submitted to audit. In an Ideal Patient Pathway each surgical patient would receive all of the seven aspects of care; this is reported as a distribution of patients recorded as receiving seven or fewer aspects of the pathway. The examples below show the results for England as a whole.

5. It was not possible to include Wales in Ideal Patient Pathway analysis, as their national cancer information system does not record a number of the key aspects.

6. As part of the NHS Transition, the cancer networks have been superseded by the Strategic Clinical Networks. The cancer networks ceased to exist from the end of March 2013 but were in existence during the period covered by the eighth Annual Report.

7. Figures over one million have been rounded to the nearest 100,000. Figures over 100,000 have been rounded to the nearest 100. Figures over 1,000 have been rounded to the nearest 10.

8. For media enquires please call 0845 257 6990 or email media@hscic.gov.uk

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