Oncology Treatment Patterns in the South

Island

Presenter: Dr Shaun CostelloCo-authors: Dr Ursula Jewell and Di Riley, SCN Manager

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Conflicts of Interest

Travel and conference Support from Pharmaceutical Company's

Honoraria for Pharma and Oncology Tech Advisory Boards

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Why are we here?

NZ – Aus All Cancer Death Rates (1990 onwards)

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SCN – Aims & Objectives

To support the improvement in patient outcomes, through reducing the impact and incidence of cancer, reducing inequalities and improving the quality of cancer services

Principle Objectives

Through integrated working and shared visionPatient Management / Information Systems Infrastructure

Access to SI-wide Cancer Intelligence

Understanding Service and Clinical Outcomes

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Focus on awareness and early diagnosis4

Addressing inequalities and support for the patient and public5

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SCN – 5 Principles

To support the improvement in patient outcomes, through reducing the impact and incidence of cancer, reducing inequalities and improving the quality of cancer services

Principle Objectives

The ‘HOW’?Capture patient-level data as part of routine patient care

Creating a shared SI-wide patient-level data repository

Conduct analyses to review and understand patterns of care

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Use information to drive change and improve care and outcomes4

Maximise access to & use of data available e.g. audit/research5

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1) Capture patient-level data as part of routine patient care:

South Island MOSAIQ roll out

Christchurch Hospital, CDHB

Nelson Hospital, NMDHB

Ashburton Hospital, CDHB

Grey Hospital,WCDHB

Oamaru Hospital, SDHB

InvercargillKew Hospital, SDHB

Dunstan Hospital, Clyde, SDHB

Clutha Health First Hospital, Balclutha, SDHB

Dunedin Hospital, SDHB

Timaru Hospital, SCDHB

Wairau Hospital, NMDHB

Planned utilisation of CDHB’s MOSAIQ system post PICS implementation

Utilisation of CDHB’s MOSAIQ system

Utilisation SDHB’s MOSAIQ system

Access to SDHB’s MOSAIQ system

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MOSAIQ is a front-line clinical system, used in oncology

MOSAIQ interfaces with the PAS to provide the following functions:

• NHI check

• Mortality check

• Transmission of patient demographic information into MOSAIQ

• Transmission of patient bookings back into PAS

• Electronic referral process (from PAS to MOSAIQ and vice versa)

• Patient-related and treatment information not isolated from

general electronic record

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2) Creating a shared SI-wide patient-level Data Repository:

METRIQ implementation

• Each data source is huge valueBUT• Linked together they are enormously powerful

METRIQ

Blue = live data importsYellow = in planning

BlueYellow

FCT

Deaths

MDM

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3) Conduct analyses to Review & Understand Patterns of Care

• Identify a suite of ‘key questions’– Keep focused on them– Involve all SCN Partners & experts

• Understand data available– Including quality & timeliness– To have ‘fit data’ need to exercise it….– Publish & polish approach

• Avoid extra data collection• Use recognised analytical techniques

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4) Use Information to Drive Change and Improve Care & Outcomes:

UK COSD example

• Report findings promptly with interpretation, the ‘so what’ approach……..

• Discuss, debate, share, consult, etc., etc.,

• Use dashboards, profiles, • Use single or multiple data sources/analyses

together – far more powerful

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5) Maximise access to and Use of Data Available, e.g. Audit/Research

SICCIS Data request and review group and guidelines

• Collect once, use multiple times

• Test data accuracy, completeness, and timeliness

– UoO summer student study in 2014/2015 showed insufficient information in METRIQ to compare differences in careplans

– Treatment details captured in METRIQ (prospectively and retrospectively) since February 2015

• Provide data quality assurance

• Data governance and guidelines

• Make data and information available to others

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METRIQ patient cohort as of 31/07/2015

METRIQ currently captures all patients who have an oncology appointment

(Medical and/or Radiation Oncology) in

• CDHB

• WCDHB

• SCDHB

• SDHB

• Both South Island private Cancer Centres (St. George’s and Mercey)

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METRIQ data items as of 24/09/2014

Demographics Diagnostics Comorbidity, 2ndary Dx Treatment Outcome

NHI Primary Site Comorbidity 1 Radiation - Location of Radiation Quality of survival (performance status)

Gender Primary Site Text Comorbidity 2 Radiation - Number of Treatments to Volume Vital Status

Name First Morph-Type & Behaviour ICD-O-3 Comorbidity 3 Radiation - Regional Dose (CGY)

Name Middle Laterality Comorbidity 4 Radiation - Regional Radiation Modality

Name Last Lymph-vascular invasion Comorbidity 5 Radiation - Subsequent Radiation Key datesName Prefix TNM-clin T Comorbidity 6 Radiation - Treatment Volume Birth DateName Suffix TNM-clin N Comorbidity 7 Radiation Beam Text remarks Date of 1st ContactName Maiden TNM-clin M Comorbidity 8 Height (cm) Date of DiagnosisMarital Status TNM-clin stage group Comorbidity 9 Weight (kg) Date of last contactTelephone TNM-path T Comorbidity 10 Chemotherapy - Treatment Date Date Treatment StartedText Occupation TNM-path N ICD-10 Secondary Diagnosis 1 Chemotherapy - Treatment Summary Date Treatment Ended

Text Remarks TNM-path M ICD-10 Secondary Diagnosis 2 Chemotherapy - Treatment Summary Date Subsequent Treatment started

Birthplace State TNM-path stage group ICD-10 Secondary Diagnosis 3 Chemotherapy Treatment Text Date of DeathAddress street TNM Edition Number ICD-10 Secondary Diagnosis 4 Hormone Therapy Treatment TextAddress 2nd line CS site specific factor ICD-10 Secondary Diagnosis 5 Hormone Therapy - Treatment Date

Address City CS tumour size ICD-10 Secondary Diagnosis 6 Hormone Therapy - Treatment Summary

Address Postal Code Grade ICD-10 Secondary Diagnosis 7 BRM - Treatment DateAddress State Regional nodes Examined ICD-10 Secondary Diagnosis 8 BRM - Treatment SummaryCounty Current Regional nodes Positive ICD-10 Secondary Diagnosis 9 BRM Therapy Treatment TextEthnicity 1 Site of distant metastasis 1 ICD-10 Secondary Diagnosis 10 Subsequent Course ChemotherapyEthnicity 2 Site of distant metastasis 2 Subsequent Course Hormone TherapyEthnicity 3 Site of distant metastasis 3 Subsequent Course BRMEthnicity 4 Diagnostic Confirmation Treatment HospitalEthnicity 5Spanish Hispanic

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What METRIQ data items actually look like…

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South Island Cancer Registrations in NZCR and METRIQ

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Overall stage group distribution for most common cancers in SI public tertiary centres Aug 2014 – Jul 2015

Overall stage group

Tertiary centre

Cancer site

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Treatment modalities for most common cancersin SI public tertiary centres Aug 2014 – Jul 2015

Tertiary centre

Cancer site

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Comparison of treatment modalities for Lung Cancer patients diagnosed Aug 2014 – Jul 2015

Overall stage group

SI Public Tertiary Centres

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Example of Radiation Regional Dose recordings for Lung Cancer patients diagnosed Aug 2014 – Jul 2015

Regional Dose in cGY

Overall stage group

SI Public Tertiary Centres

Number of records

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Goal for METRIQ: National/International Benchmarking

• > 2M cases (US, 1985 to present)

• data includes detailed tumour descriptions, treatments (radiation, hormonal, chemotherapy, biological and surgical), and survival outcomes in both outpatient and inpatient settings

• pre-validated source of timely, longitudinal cancer data for population-based research

Top 10 Cancers in NODA for 2007

First Course of Treatment for Breast Cancer by AJCC stage

5-Year Survival Rates for Breast Cancer by stage 2003-2007

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Conclusion and next steps

• METRIQ offers the opportunity to collate ‘real-time’ clinical data

• Accuracy of information is dependant on

– data entry in the clinical setting

– Clinical input and regional agreement on definitions for MOSAIQ data fields and translation tables

• Appraisal of METRIQ in light of the new Cancer IT strategy

• Audit accuracy, completeness, and timeliness

• Add further data sources to achieve complete regional view of cancer

• Make data and information available to others

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The Ascent of Knowledge Mountain!

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CDHBCDHB OncologyDrew WinterAndy SavinRob HallinanIain WardBridget RobinsonScott BabingtonDavid GibbsNigel MillerCDHB IT teamAaron PenmanChris Dever

It’s all team work… Thank you!

SDHBSDHB OncologyNatasha RobinsonTherese DuncanLynda DaggSimon PointerChris JacksonBlair McLarenShaun CostelloAndrew BowersSDHB IT teamSapna BoyceJohn Simpson

SCDHBBelinda DoreAnna MacDonald

WCDHBMary MarrAndrea ReilleyJenny Boote

NMDHBRosey WilsonPhil Gibbs

St George’s Cancer Care CentreViv AliSt George’s IT team