Cancer Mortality TargetMeasuring and Monitoring at a National Level

Jennifer Benjamin, Department of HealthKathy Elliott, National Cancer Action TeamN&YCRIS, Cancer Mortality Reduction Rates Workshop 27 July 2009

Presentation Overview

• Policy Commitments

• How the targets were set

• Progress to date

• Ongoing performance management & assessment

• Observations

• Conclusions and Q&A

Policy Commitments

Cancer Targets

• Cancer mortality target < 75– Reduce mortality rates for England by at

least 20%

• Inequality gap < 75– Reduce the absolute gap in mortality

rates between England and the Spearhead Groups by at least 6%

Interventions to achieve the target

Potential improvements in total cancer

mortality due to specific intervention

in persons under age 75*

Reduction in tobacco consumption - 7.3%

Improvement in provision of treatment services - 4%

Increase in fruit and vegetable consumption - 4%

Reduction in heavy alcohol consumption - 1% Cervical screening with incremental improvement of quality - 1% Colorectal screening# - 0. 5% Reduction in domestic radon levels - 0.2%

Breast screening with incremental improvement in quality - 2%

# phased introduction of new modalities

Source: Prof Nick Day Institute of Public Health, Cambridge

Target reduction - 20%

Total cancer mortality

*estimates produced for the under 65 age group and assumed to apply equally to under 75 age group

Setting the target

• National trends

• Looked at comparable countries

• Modelling based on possible interventions

• Conclusion: “Challenging but achievable”

Cancer Mortality Target20% reduction

Target Measure* (Year)

Baseline 141.2 (1995/6/7)

Latest actual 115.5 (2004/5/6)

Target 113.0 (2009/10/11)

Final day of the target period will be 31 Dec 2011. The mid-point target period is 2010. * 3 year average mortality rate per 100,000

Cancer Mortality TargetInequality Gap 6% reduction

Target Measure (Year)

Baseline 20.7 (1995/6/7)

Latest actual 18.0 (2005/6/7)

Target 19.5 (2009/10/11)

Final day of the target period will be 31 Dec 2011. The mid-point target period is 2010. * 3 year average mortality rate per 100,000

Progress on cancer mortality target

• Mortality rate from cancer for people aged under 75 has reduced since baseline from 18.2% to 115.5 (2005-07),

• Nearly 9,000 lives were saved in 2007 compared with 1996.

• There were 61,921 deaths (2007)

• Lowest recorded rate

Progress on cancer mortality target

Progress on inequality gap

• Three year average mortality rates for cancer under 75 for the Spearhead Group have fallen for each period since baseline.

• Gap has reduced by 13.2% since the baseline compared to the target of at least 6% in 2009-11.

Progress on inequality gap

Ongoing Performance, Management and Assessment

• National target and Inequalities Gap published annually

• Care Quality Commission Periodic Review 09/10– Reduction in <75 mortality rate– All age all cause mortality

• PCT Operating Plan (Vital Signs)

• Local Area Agreements

Observations

• DH also interested in local variations• Important that local targets are managed

by local health communities• Support current efforts to look at outliers

and the potential underlying causes• May need to focus on specific cancers e.g.

breast and colorectal• New interventions may have an impact

e.g. public awareness and early diagnosis

Conclusions

• National trend – right direction and will continue to be monitored at a national level

• Interested in local variations and the impact locally as well as nationally

• Targets helps to focus effort

The National Awareness and Early Diagnosis Initiative (NAEDI)

Mortality rates in baseline assessments, 2012 and other local targets

Kathy Elliott - National Cancer Action Team

Jennifer Benjamin - Department of Health

Cancer Mortality Reduction Rates – Workshop to look at the 2010 Targets

NYCRIS - July 2009

Presentation Overview

• Local variation by Cancer Network

• Local ambition or targets

• Awareness and early diagnosis (NAEDI)

• Baseline assessments

• Local progress and focus

• Beyond 2010 – local ambition and value for money

Relative change in cancer mortality by cancer network since 1997

"Good"

"Good"

Relative change in mortality rates and the level of change in mortality rates since 1997 (compared to England level) by cancer network.5 year rolling age-standardised mortality rates (2001-2005) for all cancers for 0-74 years age group; % change in mortality rates since 1997

National Cancer Action Team

Cancer Reform Strategy

...the Department of Health will work through the National Cancer Equalities Initiative with SHAs and PCTs to agree challenging goals for reducing cancer mortality in every cancer network area by 2012. These goals will pay particular attention to tackling the different forms of inequality... as a means to reducing overall mortality. The progress made by each PCT, cooperating through the cancer network, in meeting these goals will form an important part of our ongoing action to reduce cancer inequalities.

(p 86 CRS)National Cancer Action Team

Local Ambition

• Vital Signs • Local Area Agreements • World Class Commissioning • Cancer Reform Strategy

• Definitions– Same as 2010 target– Inequalities/ Gaps– Within another – eg life expectancy– Site specific

Awareness and Early Diagnosis The Core Hypothesis

1. Low public awareness and/or negative beliefs about cancer

2. Late presentation to GPs

3. Delays in primary care (awareness/ attitudes/access to diagnostics)

4. Late referral to hospital

5. Delays in secondary care

6. More advanced disease at diagnosis

7. Poor survival rates

8. Avoidable deaths

Baseline assessments• To help identify variation at Cancer Network, PCT and General

Practice level• To inform local awareness and early diagnosis strategy• Core indicators

– One year and five year survival rates– One year survival rates against international benchmarks– Screening uptake and coverage– Referral rates and emergency admission– Mortality

• New information– CAM; Primary Care Audit; Staging Data

• Production of a guide to aid Cancer Networks and PCTs

Key Actions – in parallel

• Local needs and priorities

• Leadership – including clinical leadership

• Local strategy, plans and ambition

• New services and service change

• Sharing learning and demonstrating impact

Awareness and early diagnosis – services and interventions

• Public understanding and the reduction of barriers to take action

• Primary care – or other entry points for patients to services

• The importance of information to monitor or evaluate as we introduce new services or initiatives

Local Cancer Ambition

• Local needs assessment– Joint Strategic Needs Assessment

• Aligning, setting and refreshing ‘ambition’– Trajectories and monitoring

• Evidence based plans– PCT Commissioning plans

• Investment

• Delivery and monitoring

Conclusions

• Local variation - understood and acted on• Clarity about how local cancer mortality

‘ambition’ will be agreed and monitored, including inequalities

• Increased confidence that interventions and new services are effective, and the time frames they will have an impact on mortality

• Fast and effective ways to share emerging and best practice

Any Questions?

Kathy ElliottNational Lead for Prevention, Early Diagnosis and InequalitiesNational Cancer Action Team

Blackberry and Mobile07799095779kathy.elliott@gstt.nhs.uk

Office 0207 972 4816kathy.elliott@dh.gsi.gov.uk

Note – please use both email addresses