Cancer Outcome Metrics

The National Cancer Registration and Analysis Service (NCRAS) has developed two cancer outcomes indicators that can be refreshed on a quarterly basis: 

Official Statistics: Emergency Presentations 

The Emergency Presentation metric shows the estimated proportion of all malignant cancers* which present as an emergency. This is also an important driver of cancer outcomes: patients with cancers that present as an emergency suffer significantly worse outcomes. The recent cancer strategy for England recommended that the proportion of emergency presentations should be regularly reported and reviewed. The metric estimates the true proportion of emergency presentations using first admissions to hospital as a proxy for diagnosis to allow more rapid reporting - see links below for further explanation.

* Excluding non-melanoma skin cancer

The spreadsheet contains emergency presentations presented at CCG and Alliance level quarterly and with a 1-year rolling average. The CCG or Alliance of interest can be selected along with a reference CCG or Alliance (or England as a whole) to compare it to.

Stage at Diagnosis

The Stage at Diagnosis metric shows the proportion of 10 cancers** diagnosed in each quarter that are recorded as presenting as an early stage case, i.e., stage 1 or 2 as opposed to stage 3, 4, or unknown.  Early stage at diagnosis is one of the most important factors that affect cancer outcomes, and promoting earlier stage at diagnosis is one of the key aims of the National Awareness and Early Diagnosis Initiative led by The Department of Health, Cancer Research UK, and Public Health England.

** Invasive malignancies of breast, prostate, colorectal, lung, bladder, kidney, ovary and uterus, non-Hodgkin lymphomas, and melanomas of skin

The tool contains stage at diagnosis presented at CCG level quarterly and with a 1-year rolling average. The CCG of interest can be selected along with a reference CCG (or England as a whole) to compare it to.

  • Early stage at diagnosis tool:  tool containing cancer outcomes metrics on the proportion of emergency presentations of cancer, and the proportion of cancers diagnosed at early stage. These are presented at CCG level quarterly and with a 1-year rolling average which combines the most recent year of data.

Update Schedule

The publication will be updated following the schedule below:

codes_update_2019

Early stage at diagnosis schedule

The planned November 2019 and January 2020 releases are delayed as the completeness of staging data for all the cancer sites required is not high enough to accurately reflect the proportion of early staged cancers. It is estimated that data completeness will be sufficiently high in April to May 2020 with the delayed January 2020 release entirely replacing the November 2019 one in this instance. The next output will include a revised definition and statistical improvements to make comparability more accurate and be published as an Experimental Official Statistic. A revised schedule for the new metric will be available here.

Notes on interpretation

Emergency Presentation:

  • There are some cancers where emergency presentation may to be the most appropriate route to diagnosis, e.g. in children’s cancers where the first symptom of underlying cancer is likely to result in an emergency presentation regardless of whether there is a suspicion of cancer or not.
  • While the measure itself may correlate with improved survival where emergency presentations fall, this is not necessarily a direct cause and many other factors will be involved.
  • The denominator is all tumours identified from Inpatient HES and therefore does not include all diagnosed tumours registered by the NCRS. As a result, the results presented here may differ from publicly available results such as Routes to Diagnosis.
  • The indicator is not adjusted for case-mix. In particular CCGs with an older population can be expected to see a larger number of Emergency Presentations. CCGs with a larger number of lung cancers (due to smoking prevalence) or smaller number of breast cancers (due to broader socio-economic factors) can be expected to see a larger proportion of emergency presentations.
  • Smaller numbers at CCG level may result in large variability in the confidence intervals.

Stage at Diagnosis:

  • This indicator aligns with the cancer stage indicators in the Public Health Outcomes Framework (PHOF indicator 2.19) and the CCG outcomes Indicator Set (CCG OIS indicators 1.17 and 1.18) on the proportion of cancers diagnosed at stages 1 and 2. 
  • The % staged is important contextual information for understanding the % early stage, as a low % staged means the data quality of the indicator is low for this CCG.  Improvement in recording of stage continues to be part of the work programme for the NCRS; the % of cases staged continues to improve year on year.
  • Improvements in this indicator are likely to be the result of improved staging coverage, so inferences about changes over time can only be made if it is clear that staging completeness did not change significantly.
  • Note that not all cancers are included in the indicator. 
  • The case-mix of cancers diagnosed will impact on the proportion of early stage cancers.  For example breast cancer is far more likely to be diagnosed at an early stage than lung cancer, so areas with a high proportion of breast cancer will have better outcomes on this indicator in comparison with areas with a high proportion of lung cancer.
  • Smaller numbers at CCG level may result in large variability in the confidence intervals.

Detailed specifications describing the indicators are also available to download: