Cancer Outcome Metrics

 

Cancer Outcomes: Stage at Diagnosis and Emergency Presentations

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

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 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

This spreadsheet contains both cancer outcomes metrics 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.

Update Schedule

The publication will be updated following the schedule below:

CODES_schedule_2

This release schedule will be reviewed when 2015 data are available for analysis.

Notes on interpretation

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.

Emergency Presentation:

  • There are some cancers, e.g. brain or children’s cancers, where emergency presentation is likely to be the most appropriate route to diagnosis.
  • 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.

Detailed specifications describing the indicators are also available to download: