Post on 28-Dec-2015
RESPONSE TO NATIONAL GUIDANCE:Information on chemotherapy use...
... How can pharmacy collect better data?Calum Polwart
Session Objectives
To provide an overview on why pharmacy need to collect data and how pharmacy can better collect useful data.
Session Objectives
To provide an overview on why pharmacy need to collect data and how pharmacy can better collect useful data.
Discuss how to bake a coffee cake!
WARNING:This session is interactive – you may need to stay awake!!
Scope of the session...
Identify some of the key data requirements
Discuss who and how collected, stored and reported
Won't discuss - specific systems
Before we begin...
The baking analogy!
Ask the audience!
Would you rather have a piece of Kinvara Coffee Cake or a piece of Tesco
Iced Coffee Cake...
What's Wrong with Tesco Cake?
Advantages:
Instant
Convenient
Consistent
Probably Cheaper!
What's Wrong with Tesco Cake?
Advantages:
Instant
Convenient
Consistent
Probably Cheaper!
Disadvantages:
Doesn't taste as nice!
Difficult to customise
Contains ingredients you may not want!
Short of things you do want!
Making the perfect coffee cake...
Making the perfect coffee cake...
200g Butter
200g Caster Sugar
4 eggs
200g SR Flour
1 tsp baking powder
1-2 tbl sp of instant coffee (2tbl sp in 100ml water)
50g walnuts
Add to lined baking tin
Bake 40mins in Preheated Oven 170C
Ice with 200g Butter, 200g Icing sugar & coffee
First step to making a good cake...
Get all your ingredients in order.
Small scale – measured out in bowls
Large scale – in vats and silos
Handling information... ...just like baking a cake
Information in the NHS...
PatientDemographics
Pathology Results
Pharmacy StockControl
ElectronicPrescribingCancer Waiting
Times
Accident &Emergency
Radiotherapy
PACS / Imaging
Information in the NHS...
PatientDemographics
Pathology Results
Pharmacy StockControl
ElectronicPrescribingCancer Waiting
Times
Accident &Emergency
Radiotherapy
PACS / Imaging
Information in the NHS...
PatientDemographics
Pathology Results
Pharmacy StockControl
ElectronicPrescribingCancer Waiting
Times
Accident &Emergency
Radiotherapy
PACS / Imaging
Data Silos
Before we bake the cake...
... we need to know exactly what sort of cake we are going to bake!
What information must we be already collecting?
Waiting time data – time to treatment
OPCS 4.4 / 4.5 HRG Data
Reference Cost Data (optional!)
Waiting Time Data...
Subsequent treats – chemo rarely breach
Waiting Time Data...
Subsequent treats – chemo rarely breach
Can your pharmacy system report any new chemotherapy drug started on a patient?
No Yes
OPCS HRG Data
Data entry:5Fu Mayo Regimen: X70.1 & X72.3
Intravesical Mitomycin: X70.1 & X72.3
A missed opportunity?
Coders really struggle with our terminologySo do we sometimes!
Do you even know if your trust is coding?
Reference Cost Data
Will set the future tariff for chemoGet it wrong and we loose out!
Reference Cost Data
Will set the future tariff for chemoGet it wrong and we loose out!Includes pharmacy on-costsForget to include it and we loose out!What should be in the on-costs?
Reference Cost Data
Will set the future tariff for chemoGet it wrong and we loose out!Includes pharmacy on-costsForget to include it and we loose out!What should be in the on-costs?
ConsumablesStaff (Pharm → ATO)QC, Maintenance, Cleaning? Electricity etcOutsourcing + dispensing costs
Doing the Reference Costs Right...
OPCS HRGProcurement Codes
PharmacyOn-Costs
Drug CostData
Doing the Reference Costs Right...
Hosp No Date Drug Cost
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £35.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
543210 03-Apr-09 Flourouracil £5.00
Doing the Reference Costs Right...Hosp No Date Drug Cost
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £35.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
543210 03-Apr-09 Flourouracil £5.00
Doing the Reference Costs Right...
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Hosp No Date Drug Cost
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £35.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
543210 03-Apr-09 Flourouracil £5.00
Doing the Reference Costs Right...
Hosp No Date Drug Cost On-Cost Total £
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £45.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Doing the Reference Costs Right...
Hosp No Date Drug Cost On-Cost Total £
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £45.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Doing the Reference Costs Right...
Hosp No Date Drug Cost On-Cost Total £
123456 01-Apr-09 Gemcitabine £350.00
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £45.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Doing the Reference Costs Right...
Hosp No Date Drug Cost On-Cost Total £
123456 01-Apr-09 Gemcitabine £350.00 £35 £385
123456 01-Apr-09 Carboplatin £45.00
123456 08-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Gemcitabine £350.00
123456 22-Apr-09 Carboplatin £45.00
123456 29-Apr-09 Gemcitabine £350.00
123456 13-May-09 Gemcitabine £250.00
123456 13-May-09 Carboplatin £45.00
123456 20-May-09 Gemcitabine £250.00
543210 01-Apr-09 Fluorouracil £5.00
543210 02-Apr-09 Fluorouracil £5.00
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Doing the Reference Costs Right...
Hosp No Date Drug Cost On-Cost Total £
123456 01-Apr-09 Gemcitabine £350.00 £35 £385
123456 01-Apr-09 Carboplatin £45.00 £30 £75
123456 08-Apr-09 Gemcitabine £350.00 £35 £385
123456 22-Apr-09 Gemcitabine £350.00 £35 £385
123456 22-Apr-09 Carboplatin £45.00 £30 £75
123456 29-Apr-09 Gemcitabine £350.00 £35 £385
123456 13-May-09 Gemcitabine £250.00 £35 £285
123456 13-May-09 Carboplatin £45.00 £30 £75
123456 20-May-09 Gemcitabine £250.00 £35 £285
543210 01-Apr-09 Fluorouracil £5.00 £25 £30
543210 02-Apr-09 Fluorouracil £5.00 £25 £30
Drug On-Cost
Carboplatin £30
Docetaxel £40
Epirubicin £25
Fluorouracil £25
Gemcitabine £35
Methotrexate £25
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Hosp No OPCS Start Date End Date Cost
123456 X71.2 01-Apr-09 21-Apr-09
123456 X71.2 22-Apr-09 12-May-09
123456 X71.2 13-May-09 03-Jun-09
543210 X71.1 01-Apr-09 14-Apr-09
543210 X71.1 15-Apr-09 29-Apr-09
678910 X71.5 02-Apr-09 28-Apr-09
678910 X71.5 29-Apr-09 31-May-09 ...
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Hosp No OPCS Start Date End Date Cost
123456 X71.2 01-Apr-09 21-Apr-09
123456 X71.2 22-Apr-09 12-May-09
123456 X71.2 13-May-09 03-Jun-09
543210 X71.1 01-Apr-09 14-Apr-09
543210 X71.1 15-Apr-09 29-Apr-09
678910 X71.5 02-Apr-09 28-Apr-09
678910 X71.5 29-Apr-09 31-May-09 ...
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Hosp No OPCS Start Date End Date Cost
123456 X71.2 01-Apr-09 21-Apr-09
123456 X71.2 22-Apr-09 12-May-09
123456 X71.2 13-May-09 03-Jun-09
543210 X71.1 01-Apr-09 14-Apr-09
543210 X71.1 15-Apr-09 29-Apr-09
678910 X71.5 02-Apr-09 28-Apr-09
678910 X71.5 29-Apr-09 31-May-09 ...
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Hosp No OPCS Start Date End Date Cost
123456 X71.2 01-Apr-09 21-Apr-09 £845
123456 X71.2 22-Apr-09 12-May-09
123456 X71.2 13-May-09 03-Jun-09
543210 X71.1 01-Apr-09 14-Apr-09
543210 X71.1 15-Apr-09 29-Apr-09
678910 X71.5 02-Apr-09 28-Apr-09
678910 X71.5 29-Apr-09 31-May-09 ...
Doing the Reference Costs Right...
Hosp No Date Drug Total £
123456 01-Apr-09 Gemcitabine £385
123456 01-Apr-09 Carboplatin £75
123456 08-Apr-09 Gemcitabine £385
123456 22-Apr-09 Gemcitabine £385
123456 22-Apr-09 Carboplatin £75
123456 29-Apr-09 Gemcitabine £385
123456 13-May-09 Gemcitabine £285
123456 13-May-09 Carboplatin £75
123456 20-May-09 Gemcitabine £285
543210 01-Apr-09 Fluorouracil £30
543210 02-Apr-09 Fluorouracil £30
543210 03-Apr-09 Flourouracil £30
Hosp No OPCS Start Date End Date Cost
123456 X71.2 01-Apr-09 21-Apr-09 £845123456 X71.2 22-Apr-09 12-May-09 £845
123456 X71.2 13-May-09 03-Jun-09 £645
543210 X71.1 01-Apr-09 14-Apr-09 £90
543210 X71.1 15-Apr-09 29-Apr-09 ...
678910 X71.5 02-Apr-09 28-Apr-09 ...
678910 X71.5 29-Apr-09 31-May-09 ...
What information should we be collecting?
Who knows?
DH standards soon!
Includes 36 data points
Many will be common sense
This weeks questions!...
What percentage of products do we supply dose banded?
This weeks questions!...
What percentage of products do we supply dose banded?
How much do we save by vial sharing?
This weeks questions!...
What percentage of products do we supply dose banded?
How much do we save by vial sharing?
Details of every patient who has had Pemetrexed...
This weeks questions!...
What percentage of products do we supply dose banded?
How much do we save by vial sharing?
Details of every patient who has had Pemetrexed...
...for non-small cell lung cancer
...how many cycles
...what doses
This weeks questions!...
What percentage of products do we supply dose banded?
How much do we save by vial sharing?
Details of every patient who has had Pemetrexed...
...for non-small cell lung cancer
...how many cycles
...what doses
How many patients do we treat with EOX, ECX and ECF?
This weeks questions!...
What percentage of products do we supply dose banded?
How much do we save by vial sharing?Details of every patient who has had
Pemetrexed......for non-small cell lung cancer...how many cycles...what doses
How many patients do we treat with EOX, ECX and ECF?
Which wards have given chemo in the last 12 months?
Experts in medicines...
Experts in medicines...
... just don't ask us how we actually are using them!
What questions does NCAG think we should be able to answer?
How many (and what proportion of) patients with different cancers are accessing chemotherapy.
Need to know:
No of patients having chemo
Tumour Type for each patient
Overall number of patients
How chemotherapy utilisation locally compares with that in other parts of the country.
Need to know:
Chemo utilisation
Standard counting method!
National comparators
How chemotherapy utilisation locally compares with that in other parts of the country.
Also need to know – why different
PS
Co-morbidities
The indications in which chemotherapy is being used (eg curative, adjuvant or
life-prolonging/palliative).
Need to know:
Treatment intent
Do we also need to know:
Tumour type?
How many cycles of treatment patients receive and how closely this corresponds with that
expected from clinical trial findings.
Need to know:
Protocol
No of cycles delivered
Clinical detail – eg diagnosis & staging
How many cycles of treatment patients receive and how closely this corresponds with that
expected from clinical trial findings.
Also need to know – why different
PS
Co-morbidities
The outcomes (eg how many patients died within a specified time of receiving treatment).
Need to know:
Protocol
Indication(diagnosis), staging
Date of Death (or Progression, or Response?)
The outcomes (eg how many patients died within a specified time of receiving treatment).
Also need to know – why different
PS
Co-morbidities
People are doing this already...
...but usually manually!
Does Size Matter? An audit of Dose Intensity in Non-Small Cell Lung CancerRachel Collinson (Clinical Pharmacist, Darlington Memorial Hospital), Clive Peedell (Consultant Oncologist, James Cook University Hospital),
Calum Polwart (Pharmacy Clinical Team Manager – Cancer & Aseptic Services, Darlington Memorial Hospital)
Doublet chemotherapy is the standard treatment for Advanced Non Small Cell Lung Cancer (NSCLC) but tolerability of the regimen remains a challenge.
Luciani et al (2009) reported dose intensities less than 80% in their elderly NSCLC treatment cohort resulted in poorer outcomes.
A NSCLC patient deferring every cycle for 7 days causes the relative dose intensity (DI) to be 75% of planned.
Preventing subsequent delays by 10% dose reduction (DR) at the first delay could result in a DI of 85%.
Clinician practice varies when dealing with treatment delays and the need to formalize this to allow nurse and pharmacist led review of patients to take place prompted a protocol driven dose reduction to be implemented within our institution.
Background
Retrospective case review was used to analyse DI from a 12 month period (from Jan 08 to Jan 09) for patients receiving Carboplatin(C) & Gemcitabine(G) Chemotherapy (C- AUC 5 on d1,G- 1250mg/m2 on d1& 8, 21d cycle)
Data was retrieved from the hospital computer systems.
Relative DI was calculated for the number of cycles delivered, relative to the planned intensity over the same number of cycles (Hryniuk 1990).
Kaplan-Meier survival analysis undertaken, including Log Rank Test (p < 0.05 was assumed to show a difference).
Cockroft & Gault and Wright Equation dose variations were assessed for possible influence on results.
Method
Usable data was retrieved from 60 patients (39 Males) with NSCLC who had received GC Chemotherapy, median age 68. 20 patients had experienced Grade II+ HT after their first cycle of chemotherapy.
Results
Age is a contributing factor to likelihood of a delay due to HT and the depth of the toxicity, however, we did not observe a difference in outcome related to age.
Unlike Luciani et al we did not observe a survival disadvantage for patients with lower dose intensities. Those patients who received reduced doses had better outcomes.
We hypothesize that patient characteristics which make the patient more sensitive to chemotherapy to require DR also make their tumours more sensitive.
Small DR may improve the possibility of maintaining DI, which may be of clinical benefit to patients.
No relationship with renal function calculation method was identified.
Patients can be re-assured that small DR to optimise treatment intensity overall do not appear to have a detrimental effect on outcome and may be beneficial.
Discussion
References
11 (27.5%) patients with Grade 0-I HT who did not DR on cycle 2 did have DR on cycle 3. 3 (18%) patients with Grade II/III HT required a second DR on cycle 3, & 1 patient with Grade IV HT had a second DR.
Toxicity after 1 cycle n rCDI rGDI n > 70 years
Grade 0 / I 39 84.7% 75.4% 8 (21%)
Grade II / III 17 68.8% 65.9% 9 (53%)
Grade IV 4 62.8% 54.3% 3 (75%)
Haematological Toxicity Day 8 Day 21
Grade 0 / I Proceed Proceed with next cycle
Grade II Proceed Delay 7 days then* reduce 10%
Grade III 75% Dose Delay 7 days then* reduce 10%
Grade IV Omit Delay 7 days then* reduce 20%
*ensure counts have recovered to Grade 0/I before proceeding with treatment
Table 1: Pharmacist & Nurse driven dose reduction schedule
Table 2: Mean relative dose intensity (rDI) for Carboplatin(C) & Gemcitabine (G) by CTC Grade of Haematological Toxicity. (n = number of patients)
Aim
To audit the effectiveness of 10% dose reductions for maintaining DI, and to compare clinical outcomes.
Hryniuk WM, Goodyear M. The calculation of received dose intensity. JCO. 1990 8(12); 1936-7Luciani A, et al. Dose intensity correlate with survival in elderly patients treated with chemotherapy for advanced non-small cell lung cancer. Lung Cancer 2009 66; 94-6
National Chemotherapy Advisory Group
Patient identifiers
Tumour type
Stage of tumour
Performance status and significant co-morbidities.
Indication (curative, palliative, adjuvant and neoadjuvant)
Treatment regimen
Line of treatment
Number of cycles planned
Number of cycles delivered
Start date
Date of death
What is 'normal' for pharmacy
Patient identifiers
Tumour type
Stage of tumour
Performance status and significant co-morbidities.
Indication (curative, palliative, adjuvant and neoadjuvant)
Treatment regimen
Line of treatment
Number of cycles planned
Number of cycles delivered
Start date
Date of death
What is 'normal' for hospitals
Patient identifiers
Tumour type
Stage of tumour
Performance status and significant co-morbidities.
Indication (curative, palliative, adjuvant and neoadjuvant)
Treatment regimen
Line of treatment
Number of cycles planned
Number of cycles delivered
Start date
Date of death
What will be 'normal' for hospitals by 2010
Patient identifiers
Tumour type
Stage of tumour
Performance status and significant co-morbidities.
Indication (curative, palliative, adjuvant and neoadjuvant)
Treatment regimen
Line of treatment
Number of cycles planned
Number of cycles delivered
Start date
Date of death
National Chemotherapy Advisory Group
Patient identifiers
Tumour type
Stage of tumour
Performance status and significant co-morbidities.
Indication (curative, palliative, adjuvant…)
Treatment regimen
Line of treatment
Number of cycles planned
Number of cycles delivered
Start date
Date of death
Performance Status
Only decisions to be made are:
ECOG / WHO Scale (0 - 5)or
Karnofsky Scale (0 – 100)
Should we write our recipe in grams or ounces! (Can we convert?)
Indication (curative, palliative etc)
Is Indication the right terminology? Would intent not be the correct term!
Fairly simple list –Although for long term survival advantages is palliative descriptive enough?
Myeloma Intensive Arms
Treatment regimen
Hardest terminology!Is FEC and ECF the same?FEC-50, FEC-60, FEC-75, FEC-100?FEC-T, FEC then T?
Can we have a national system?
Is the OPCS Code List enough?
OPCS Coding List
REGIMEN NAME USUAL CYCLE LENGTH DAYS
OPCS PROCUREMENT CODE
OPCS DELIVERY CODE
FEC 60 / 75EPIRUBICINCYCLOPHOSPHAMIDEFLUORURACIL
21 X70.2 X72.1
FEC100EPIRUBICINCYCLOPHOSPHAMIDEFLUORURACIL
21 X70.3 X72.1
OPCS Coding List
REGIMEN NAME USUAL CYCLE LENGTH DAYS
OPCS PROCUREMENT CODE
OPCS DELIVERY CODE
FEC 60 / 75EPIRUBICINCYCLOPHOSPHAMIDEFLUORURACIL
21 X70.2 X72.1
FEC100EPIRUBICINCYCLOPHOSPHAMIDEFLUORURACIL
21 X70.3 X72.1
Procurement costs differ different entriesClinically FEC-60 and FEC-75 differ…
How can we capture Regimen?
DH: Electronic Prescribing
Pharmacy System?
Coders??
Cancer Information System
Something special?
Electronic Prescribing?
Lots of Promises – can it deliver?
Data in ≠ Data out
Still a silo! Where will you store:
Date of deathStagingCostsNon-chemo patients
Have we missed anything?
Outcomes:Survival easier than PFS Survival easier than Response
Toxicity?At least we have a standard system!Can the prescribing systems help?
Summary
Pharmacy should care about drug use dataData should be clinical not just financialElectronic Systems will be mandatoryPutting data into a silo does not mean it can come back outIf the data isn't going in it definitely can't come outBeware unproven promises
Final Thought
The home baked cake may be better than the shop bought cake...
Final Thought
The home baked cake may be better than the shop bought cake...
... but beware – not everyone's home baking is that good!