Head and Neck Cancer - ISD Scotland · 2 QPI Title Amend to‘Patients with head and neck cancer...

Head and Neck Cancer

Measurability of Quality Performance Indicators Version 3.2

To be read in conjunction with:

Head and Neck Cancer QPIs (latest version published)

Head and Neck Cancer QPI Dataset (latest version published)

Head and Neck Cancer Measurability Document v3.2 2

Measurability of Quality Performance Indicators for Head and Neck Cancer Please refer to the Head and Neck Cancer Quality Performance Indicators published by Healthcare Improvement Scotland for a full description of individual QPIs Please refer to the Head and Neck Cancer QPI Dataset published by ISD Scotland for a full description of individual data items

Document control: This Version

Title Head and Neck Cancer Measurability of QPIs Version/Issue Number 3.2

Effective From April 2015 (TNM8 changes from April 2019) Author Jane Garrett, ISD

Document Type Guidance Document status Final

Document Purpose Final

Summary of changes Detailed below

V3.0 August 2018

Final In addition to reporting by Hospital of Diagnosis, the following QPIs should also be reported by Board of Surgery:

QPI: 8, 11(surgery)

Revision History

Version Date Status Summary of Changes QPI (s)

0.1 Oct 2013 Draft First Draft All

0.2 Oct 2013 Draft Changes following Public Engagement All

0.3 Mar 2014 Draft Changed following dataset finalisation meeting All

1.1 Apr 2014 Final Removed QPI 11 - Time to Adjuvant Treatment and renumbered QPI 12 – 30 Day Mortality 11

1.2 June 2014 Final Amendments made out-with review, incorporating additional data item into the dataset updating the MDT QPI 3

1.3 Sept 2014 Final Amendments made out-with review, incorporating changes made to Definitive operative Procedure 8;10

1.4 Nov 2014 Final Change in version number due to validation changes n/a

1.5 Nov 2014 Final Change in version number due to validation changes n/a

2.0 Mar2015 Final Amendments following 9 month review, creating version 2 for use on 1st day 2

nd year of data collection. All

2.1 Aug 2015 Final Amendments out-with review 1,3,4,8,9,10

2.2 Aug 2015 Final Amendments out-with review 5, 7, 8, 9

2.3 Mar 2016 Final Amendments following Baseline Review 1,2,3,4,5,6,7,8,10,11

2.4 May 2016 Final Correction of Head & Neck Cancer QPI version n/a

2.5 Sept 2016 Final Amendments out-with review 5, 6, 7

3.0 August 2018 Final Amendments following Formal Review. NB: Formal Review measurability changes apply to patients diagnosed in year 4 data collection (01/04/2017 - 31/03/2018) with the exception of measures which require new data items. These changes will apply to patients diagnosed in year 5 data collection (01/04/2018 - 31/03/2019). This will apply to the QPI’s listed:

Year 4: QPIs 1, 2 (except spec ii), 3, 6, 7, 8, 9, 10 and 11 Year 5: QPIs 2 (spec ii), 4, 5

3.1 April 2019 Final Amendments due to TNM8 5, 9

3.2 April 2019 Final Amendments out-with review 1, 2, 3, 4, 5, 6,

http://www.healthcareimprovementscotland.org/programmes/cancer_care_improvement/cancer_resources/cancer_qpis.aspx

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Audit/


7, 11

Updates from Previous Version

QPI Summary of changes (excluding formatting changes) (April 2019)

1 Num amend 10/10/1010 to 10/10/1900; NR Num amend 09/09/0909 to 09/09/1900

2 Num (ii) amend 10/10/1010 to 10/10/1900; NR Num amend 09/09/0909 to 09/09/1900; NR Den amend 09/09/0909 to 09/09/1900



5 Num (ii) amend 10/10/1010 to 10/10/1900; NR Num amend 09/09/0909 to 09/09/1900

6 Num amend 10/10/1010 to 10/10/1900; Num amend 09/09/09 to 09/09/1900 ;NR Num amend 09/09/0909 to 09/09/1900


11 Num (i) amend 10/10/1010 to 10/10/1900; Num (ii) amend 10/10/1010 to 10/10/1900; NR Num amend 09/09/0909 to 09/09/1900

QPI Summary of changes (excluding formatting changes) (April 2019) Implement from April 2019

5 Den(i) add T1a and T1b; Den(ii) add T1a and T1b 9 Den add T1a and T1b

QPI Summary of changes (excluding formatting changes) (August 2018)

1 Den Amend ‘No exclusions’ to ‘Excluding patients who died before treatment and patients who refuse treatment’; Add ‘AND Type of First Cancer Treatment not coded as Patient died before treatment or Patient refused all therapies’,’ AND [FIRSTTREATTYPE <> 94 OR 95]’, NR Exc Amend ‘N/A’ to ‘[FIRSTTREATTYPE = 99]’

2 QPI Title Amend to ‘Patients with head and neck cancer should undergo computerised tomography (CT) and/or Magnetic resonance imaging (MRI) of the primary site and draining lymph nodes with CT of the chest to determine the extent of disease and guide treatment decision making.’ Desc Amend to ‘Proportion of patients with head and neck cancer who undergo CTand/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment and where the report is available within 2 weeks of the final imaging procedure.Please note: The specifications of this QPI are separated to ensure clear measurement of the following: (i) Patients with head and neck cancer who are evaluated with appropriate imaging before the initiation of treatment. (ii) Patients with head and neck cancer who are evaluated with appropriate imaging before the initiation of treatment where the report is available within 2 weeks of the final imaging procedure. Num(i) Amend to Number of Patients with head and neck cancer who undergo CTand/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment; delete ‘or Date of First Cancer treatment coded as inapplicable’, ‘OR [FIRSTTREATDATE = 10/10/1010]’. Den(i) Add ‘patients who died before treatment and patients who refuse treatment)’, ‘AND Type of First Cancer Treatment not coded as Patient died before treatment or Patient refused all therapies’, ‘AND [FIRSTTREATTYPE <> 94 OR 95]’, Add Num(ii) and Den(ii); NR Num Add (i), (ii) [CTREPORTDATE = 09/09/0909] OR [CTDATE = 09/09/0909]; NR Exc Add (i), (ii), ‘OR [FIRSTTREATTYPE = 99]’; NR Den Add (i), (ii) [SITE= C99.X] OR [CTINVEST = 99] OR [CTDATE = 09/09/0909] OR [FIRSTTREATDATE = 09/09/0909]

3 QPI Title Delete ‘newly diagnosed’; Amend ‘prior to’ to ‘before’; Den Delete ‘diagnosed’; NR Den Delete ‘OR [MORPHOL = 9999/9] 4 QPI Title Amend ‘referred’ to ‘offered referral’, Add ‘before first treatment’; Desc Amend ‘referred’ to ‘offered referral’ Num Amend ‘referred’ to ‘offered

referral’ 5 Heading Amend to ‘Oral and Dental Rehabilitation Plan’; Title Amend to ‘Patients whose head and neck cancer treatment may affect oral and dental

appearance and function should have an assessment co-ordinated by a Consultant in Restorative Dentistry before initiation of treatment’; Desc Amend to ‘Proportion of patients with head and neck cancer deemed in need of an oral and dental rehabilitation plan who have an assessment before initiation of treatment. Please note: The specifications of this QPI are separated to ensure clear measurement of the following: (i)Patients in whom the decision for requiring pre-treatment assessment

a has been made jointly by Consultants in Restorative Dentistry and the MDT; and (ii)Patients who


QPI Summary of changes (excluding formatting changes) (Sept 2016)

5 Numerator inserted ‘[DENSCREEN <> 10/10/1010 OR 09/09/0909]’ 6 Numerator inserted ‘[NUTSCREEN <> 10/10/1010 OR 09/09/0909] 7 Numerator inserted ‘[SLTDATE <> 10/10/1010 OR 09/09/0909]’

QPI Summary of changes (excluding formatting changes) (May 2016)

require pre-treatment assessment that have this carried out before initiation of treatment. Num(i) Amend to ‘Number of patients with head and neck cancer undergoing active treatment in whom the decision for requiring pre-treatment assessment has been made jointly by Consultants in Restorative Dentistry and the MDT. Oral Assessment Required coded as Yes or No [ORALREQ = 01 or 02]; Den(i) Add ‘undergoing active treatment’, Delete ‘and patients undergoing no active treatment as part of their primary therapy)’, Amend ‘Clinical’ to ‘Final’, Delete ‘ not’, Amend ‘supportive care or watchful waiting’ to ‘surgery, radiotherapy, chemotherapy or chemoradiotherapy, Amend ‘<>7 or 12’ to ‘=1 OR 2 OR 3 OR 15’; Footer Add ‘

a This specification

measures whether a joint decision on the requirement for pre-treatment assessment has been agreed regardless of the outcome i.e. whether pre-treatment assessment is required or not; Add Num(ii), Den(ii); NR Num Add ‘[ORALREQ = 99]; NR Exc Add ‘And (ii)’; Delete ‘OR [FIRSTTREATTYPE = 99]; NR Den Add ‘(i) [SITE=C99.X] OR [FIRSTTREATTYPE=99], Add ‘OR [ORALREQ = 99]’

7 Desc Add ‘undergoing treatment with curative intent’; Num Add ‘undergoing treatment with curative intent’, Amend to Date of Specialist Speech and Language Therapist Access not coded as Not performed; AND Intent of Definitive Surgery coded as curative AND Date of Specialist Speech and Language Therapist Access before or equal to Date of Definitive Surgery OR Radiotherapy Course Type {Head and Neck Cancer} coded as Radical or Chemoradiotherapy AND Date of Specialist Speech and Language Therapist Access before or equal to Date Treatment Started (Radiotherapy) {Head and Neck Cancer} SLTDATE <> 10/10/1010] AND (([OPINTENT = 01] AND [SLTDATE ≤ SURGDATE]) OR ([RCOURSETYPE1 OR RCOURSETYPE2 = 2 or 6] AND [SLTDATE ≤ RSTARTDATE1-2]))’; Den Add ‘undergoing treatment with curative intent’, ‘AND Intent of Definitive Surgery coded as Curative; OR Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Radical or Chemoradiotherapy; AND’, ‘AND [OPINTENT = 01] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 2 or 6]’; NR Num Amend ‘[FIRSTTREATDATE = 09/09/0909]’ to ‘OR [SURGDATE = 09/09/0909] OR [RSTARTDATE1 OR RSTARTDATE2 = 09/09/0909]’; NR Den Add ‘OR [OPINTENT = 99] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 99]’

8 QPI Title Delete ‘not’, ‘in’; Desc Amend ‘Head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’; Num Amend ‘Head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’; Den Amend ‘Head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’, Add ‘and Site of origin of Primary Tumour {Cancer} not coded as Posterior wall of oropharynx or Posterior wall of hypopharynx’, Amend ‘No exclusions’ to ‘(Excluding patients with naso-pharyngeal cancer and patients with posterior pharyngeal wall cancer’, Add ‘AND Morphology of Tumour coded as Squamous Cell Carcinoma’, Amend ‘Head or Neck Cancer’ to ‘oral cavity, larynx or pharynx; AND’, Add ‘[MORPHOL = 8051/3 OR 8052/3 OR 8070/3 OR 8071/3 OR 8072/3 OR 8073/3 OR 8074/3 OR 8075/3] AND’, Delete ‘C07 OR C08 OR’, ‘C11 OR’, ‘C30 OR C31 OR’, ‘OR C76’, ‘OR ( [SITE = C41.0 OR C41.1]) )’, Add ‘AND [SITE <> C10.3 or C13.2]’; NR Exc Add ‘NB Patients not recorded for SITE

are excluded from the denominator’; NR Den Add ‘[MORPHOL = 9999/9] OR’ 9 Den Amend ‘Clinical’ to ‘Final’ 10 QPI Title Amend ‘Head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’, Add ‘Nodal’, Amend ‘final excision’ to

‘involved’, Delete ‘of ()’; Desc Amend ‘head and neck cancer who have’ to ‘with squamous cell carcinoma of the oral cavity, larynx or pharynx with nodal’, Amend ‘final excision’ to ‘involved’, Delete ‘of ()’; Num Amend ‘head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’, Add ‘nodal’, Amend ‘final excision’ to involved’, Delete ‘of ()’; Den Amend ‘head and neck cancer’ to ‘squamous cell carcinoma of the oral cavity, larynx or pharynx’, Add ‘nodal’, Amend ‘involved’ to ‘final excison’, Delete ’of ()’, Amend ‘No exclusions’ to ‘(Excluding patients with performance status 2, 3 or 4, patients with naso-pharyngeal cancer and patients with oral (lip) cancer’, Add ‘AND Morphology of Tumour coded as Squamous Cell Carcinoma’, Amend ‘Head or Neck Cancer’ to ‘oral cavity, larynx or pharynx’, Add ‘ AND WHO/ECOG Performance Status not coded as 2 or 3 or 4. Add ‘[MORPHOL = 8051/3 OR 8052/3 OR 8070/3 OR 8071/3 OR 8072/3 OR 8073/3 OR 8074/3 OR 8075/3] AND’, Delete ‘C00.3 OR C00.4 OR C00.5 OR’, ‘C07 OR C08 OR’, ‘C11 OR’, ‘OR C30 OR C31’, ‘OR C76] OR ( [SITE = C41.0 OR C41.1]) )’, Add ‘AND [PSTATUS <> = 2 or 3 or 4]’, NR Exc Amend ‘N/A’ to ‘NB Patients not recorded for SITE are excluded from the denominator’, NR Den Add ‘[MORPHOL = 9999/9] OR’, Delete ‘[SURGDATE = 09/09/0909] OR’, Add ‘OR [PSTATUS = 9]‘


FC Correction of Head & Neck Cancer QPI version from V1.0 to V2.0

QPI Summary of changes (excluding formatting changes) (March 2016)

1 Numerator inserted ‘or Date of First Cancer Treatment coded as inapplicable’ – OR [FIRSTTREATDATE = 10/10/1010]

2 Numerator inserted ‘or Date of First Cancer Treatment coded as inapplicable’ – OR [FIRSTTREATDATE = 10/10/1010]; Denominator inserted ‘(Excluding patients

who undergo diagnostic excision biopsy as the definitive surgery), inserted ‘AND Intent of Definitive Surgery not coded as diagnostic excision biopsy only’ – AND [OPINTENT <> 03]; NR Exclusion inserted ‘ [OPINTENT = 99]’

3 Denominator inserted ‘and patients who undergo diagnostic excision biopsy as the definitive surgery’, ‘AND Intent of Definitive Surgery not coded as diagnostic

excision biopsy only’ – ‘AND [OPINTENT <> 03]’; NR Exclusion inserted ‘OR [OPINTENT = 99]

4 Numerator inserted ‘or Date of First Cancer Treatment coded as inapplicable’ – ‘OR [FIRSTTREATDATE = 10/10/1010]’

5 QPI Title replaced ‘pre-operative’ to ‘pre-treatment’; Description removed ‘pre-operative’; Numerator removed ‘pre-operative’, amended equation from ‘Date of Oral

Assessment (Pre-operative) coded as before Date of First Cancer Treatment; and Date of Oral Assessment (Pre-operative) not coded as Not performed’ – ‘[DENSCREEN < FIRSTTREATDATE] AND [DENSCREEN <> 10/10/1010]’ to ‘Date of Oral Assessment (Pre-treatment) coded as before or equal to Date of First

Cancer Treatment or Date of First Cancer Treatment coded as inapplicable; and Date of Oral Assessment (Pre-operative) not coded as Not performed.’ – ‘[DENSCREEN ≤ FIRSTTREATDATE] OR [FIRSTTREATDATE = 10/10/1010] AND [DENSCREEN <> 10/10/1010]’; Denominator inserted additional exclusion ‘and

patients undergoing no active treatment as part of their primary therapy’, inserted ‘and Type of First Cancer Treatment not coded as supportive care or watchful waiting’ – AND [FIRSTTREATTYPE <> 7 or 12]’; NR Exclusion inserted ‘OR [FIRSTTREATTYPE = 99]

6 Numerator inserted ‘or equal to’ – ‘≤’ between Date of Nutritional Screening and Date of First Cancer Treatment; added ‘or Date of First Cancer Treatment coded as

inapplicable’ – ‘OR [FIRSTTREATDATE = 10/10/1010]’

7 Numerator inserted ‘or equal to’ – ‘≤’ between Date of Specialist Speech and Language Therapist Access and Date of First Cancer Treatment; added ‘or Date of First

Cancer Treatment coded as inapplicable’ – ‘OR [FIRSTTREATDATE = 10/10/1010]’

8 QPI Title amended from ‘Patients with head and neck cancer undergoing surgical resection with curative intent should have their tumour adequately excised.’ To ‘Patients with head and neck cancer undergoing open surgical resection with curative intent should not have their tumour inadequately excised.’ Description amended from ‘Proportion of patients with head and neck cancer who undergo surgical resection with curative intent where R0a

resection is achieved.’ To ‘Proportion of patients with head and neck cancer with final excision margins of less than 1mm after open surgical resection with curative intent.’; Numerator changed from ‘Number of patients with head and neck cancer who undergo curative surgical resection where R0a

resection is achieved. - Surgical Margins coded as Margins confirmed as clear. - [SURGMARG = R0]’ To ‘Number of patients with head and neck cancer who undergo open surgical resection with curative intent with final excision margins of less than 1mm (on pathology report).-.Surgical Margins coded as ‘<1mm’.- [SURGMARG = 03]’; Removal of reference ‘

a RO resection is a surgical resection where surgical margins are clear of microscopic

disease.’ Denominator separation into Oral resection, Oropharyngeal resections & Larynx resections has been removed and replaced with ‘All patients with head and neck cancer who undergo open surgical resection with curative intent. (No exclusions).- Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; Definitive Operative Procedure {Head and Neck Cancer} not coded as Microlaryngoscopy-laser removal lesion or Microlaryngoscopy-cold removal lesion or Endoscopic Destruction of Lesion of Larynx or Endoscopic partial laryngectomy or Laser excision lesion hypopharynx/oropharynx or Laser excision lesion nasopharynx; and Intent of Surgery coded as Curative.- ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR -C13 OR C14.0 OR C14.8 OR C30 OR C31 OR -C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 OR OPCODE5 OR OPCODE6 OR OPCODE7 OR OPCODE8 OR OPCODE9 <> E34.1 OR 34.2 OR E35.3 OR E35.6 OR Y08.2] AND [OPINTENT = 01]’

10 QPI Title, Description & Numerator - ‘R1 surgical margins’ replaced with ‘final excision margins of <1mm; Denominator - ‘R1 surgical margins’ replaced with ‘final

excision margins of <1mm, changed Surgical Margins coded as ‘ R1’ to ‘<1mm’

11 ’30 Day Mortality’ changed to ’30 and 90 Day Mortality’; QPI Title changed to ’30 and 90 day mortality after curative treatment for Head and Neck Cancer.’

Description ‘or 90 days’ added; Numerator split into (i) and (ii) with the addition of (ii) ‘Number of patients with head and neck cancer who undergo curative treatment who die within 90 days of treatment. - Date of Death is not coded as inapplicable and is within 90 days of date of curative treatment [either – SURGDATE / RCOMPDATE1-2 /

Surgery - [DOD – SURGDATE ≤ 90] AND [DOD <> 10/10/1010]

Radical Radiotherapy - [DOD – RCOMPDATE1-2 ≤ 90] AND [DOD <> 10/10/1010]

Chemoradiotherapy - ( [DOD – RCOMPDATE1-2 ≤ 90] OR [DOD – CHEMENDATE1-2 ≤ 90] ) AND [DOD <> 10/10/1010]


Denominator now labelled ‘(i) and (ii)’


5 The following codes inserted into denominator NOT (SITE = C32.0A, C32.0B, C32.0C, C32.1A, C32.1B, C32.1D, C32.1E, C32.3A, C32.3A2, C32.3B and C32.3C)





1 NR numerator amend from [HCDIAG = 99] OR [HDIAG = 09/09/0909] to [FIRSTTREATDATE = 09/09/0909] OR [HDIAG = 09/09/0909]

3 Denominator amend FIRSTTREATDATE to FIRSTTREATTYPE, NR for Exclusion amend FIRSTTREATDATE to FIRSTTREATTYPE, NR for Denominator add OR [MORPHOL = 9999/9]

4 NR Numerator spelling error SMOKECESS changed to SMOKCESS

8 Numerator amend [SURGMARG = 01] to [SURGMARG = R0]

9 NR for Exclusion remove [RCOURSETYPR1 OR RCOURSETYPE2 = 99] and insert NB Patients not recorded for RCOURSETYPE are excluded from the denominator.

10 NR for Denominator remove OR [DEXCAPSPREAD = 09/09/0909]

QPI Summary of changes (excluding formatting changes) (March 2015)

1 Removed AND MORPHOL = 9270/3 from denominator; NR numerator changed HCDIAG to HDIAG; NR denominator removed OR MORPHOL = 9999/9

2 Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

3

Numerator amended to Date Discussed by Care Team (MDT) not coded as not applicable AND Date Discussed by Care Team (MDT) less than or equal to Date of Definitive Treatment OR Date of Definitive Treatment equal to not applicable [MDTDATE <> 10/10/1010] AND ([MDTDATE ≤ DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010]); Removed AND MORPHOL = 9270/3 from denominator; Denominator changed FIRSTTREATDATE <>94 to FIRSTTREATDATE <> 09/09/0909; NR exclusion FIRSTTREATDATE = 99 changed to FIRSTTREATDATE = 10/10/1010

4 Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

5 Denominator SITE C01-C13 expanded OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR; C30-C32 expanded C31 added; Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

6 Denominator SITE C01-C13 expanded OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR; C30-C32 expanded C31 added; Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

7 Denominator SITE C02-C06 and C09-C13 expanded to OR C03 OR C04 OR C05 OR and OR C10 OR C11 OR C12 OR; NR denominator removed OR

MORPHOL = 9999/9

9 Denominator SITE C01-C13 expanded OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR; C30-C32 expanded C31 added Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

10 Denominator SITE C01-C13 expanded OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR; C30-C32 expanded C31 added Removed AND MORPHOL = 9270/3 from denominator; NR denominator removed OR MORPHOL = 9999/9

11 Removed AND MORPHOL = 9270/3 from denominator – Surgery, Radical Radiotherapy, Chemoradiotherapy; NR denominator removed OR MORPHOL = 9999/9 – Surgery, Radical Radiotherapy, Chemoradiotherapy

QPI Summary of changes (excluding formatting changes) (September 2014)

8 Denominator - Add OR OPCODE6 OR OPCODE7 OR OPCODE8 OR OPCODE9; NR for Denominator – Remove OPCODE2 AND OPCODE3 AND OPCODE4 AND


OPCODE5

10 Denominator - Add OR OPCODE6 OR OPCODE7 OR OPCODE8 OR OPCODE9; Change code V07.8 to V06.8 and Remove duplicate code E14.8; NR for

Denominator – Add OR [OPCODE1 = 99]


QPI 1 – Pathological Diagnosis of Head and Neck Cancer

QPI Title:

Patients with head and neck cancer should have a cytological or histological diagnosis before treatment.

Description:

Proportion of patients with head and neck cancer who have a cytological or histological diagnosis before treatment.

Numerator

Number of patients with head and neck cancer who have a cytological or histological diagnosis before treatment.

Date of Histological/Cytological Diagnosis {Cancer} not coded as not applicable; and Date of Histological/Cytological Diagnosis {Cancer} before or equal to Date of First Cancer Treatment or Date of First Cancer Treatment coded as inapplicable .

[HDIAG <> 10/10/1900] AND [HDIAG ≤ FIRSTTREATDATE] OR [FIRSTTREATDATE = 10/10/1900]

Denominator

All patients with head and neck cancer. (Excluding patients who died before treatment and patients who refuse treatment).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; AND Type of First Cancer Treatment not coded as Patient died before treatment or Patient refused all therapies.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [FIRSTTREATTYPE <> 94 OR 95]

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [FIRSTTREATDATE = 09/09/1900] OR [HDIAG = 09/09/1900]

Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [FIRSTTREATTYPE = 99]

Not recorded for denominator

Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X]


QPI 2 – Imaging

QPI Title:

Patients with head and neck cancer should undergo computerised tomography (CT) and/or Magnetic resonance imaging (MRI) of the primary site and draining lymph nodes with CT of the chest to determine the extent of disease and guide treatment decision making.

Description:

Proportion of patients with head and neck cancer who undergo CT and/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment and where the report is available within 2 weeks of the final imaging procedure. Please note: The specifications of this QPI are separated to ensure clear measurement of the following:

(i) Patients with head and neck cancer who are evaluated with appropriate imaging before the initiation of treatment.

(ii) Patients with head and neck cancer who are evaluated with appropriate imaging before the initiation of treatment

where the report is available within 2 weeks of the final imaging procedure.

Numerator (i)

Number of Patients with head and neck cancer who undergo CT and/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment.

Imaging Completed (Pre-treatment) coded as Yes; and Date of Imaging Completed (Pre-treatment) before Date of First Cancer Treatment.

[CTINVEST = 01] AND [CTDATE ≤ FIRSTTREATDATE]

Denominator (i)

All patients with head and neck cancer. (Excluding patients who undergo diagnostic excision biopsy as the definitive surgery, patients who died before treatment and patients who refuse treatment).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; AND ‘Intent of Definitive Surgery’ not coded as diagnostic excision biopsy only; AND Type of First Cancer Treatment not coded as Patient died before treatment or Patient refused all therapies.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [OPINTENT <> 03] AND [FIRSTTREATTYPE <> 94 OR 95]

Numerator (ii)

Number of Patients with head and neck cancer who undergo CT and/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment where the report is available within 2 weeks of the final imaging procedure. Date Imaging Reported (Pre-treatment) minus Date of Imaging Completed (Pre-treatment) is less than or equal to 14 days [CTREPORTDATE – CTDATE ≤ 14 days] AND [CTREPORTDATE <> 10/10/1900]

Denominator (ii)

All patients with head and neck cancer who undergo CT and/or MRI of the primary site and draining lymph nodes with CT of the chest before the initiation of treatment. (Excluding patients who undergo diagnostic excision biopsy as the definitive


surgery, patients who died before treatment and patients who refuse treatment).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; and Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; and Imaging Completed (Pre-treatment) coded as Yes; and Date of Imaging Completed (Pre-treatment) less than or equal to Date of First Cancer Treatment; and Intent of Definitive Surgery not coded as diagnostic excision biopsy only; and Type of First Cancer Treatment not coded as Patient died before treatment or Patient refused all therapies.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR

C41.1]) ) AND ([CTINVEST = 01] AND [CTDATE ≤ FIRSTTREATDATE]) AND [OPINTENT <> 03] AND [FIRSTTREATTYPE

<> 94 OR 95]

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target

(i) [CTINVEST = 99] OR [CTDATE = 09/09/1900] OR [FIRSTTREATDATE = 09/09/1900]

(ii) [CTREPORTDATE = 09/09/1900] OR [CTDATE = 09/09/1900]

Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard.

(i) and (ii) [OPINTENT = 99] OR [FIRSTTREATTYPE = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard

(i) [SITE = C99.X]

(ii) [SITE = C99.X] OR [CTINVEST = 99] OR [CTDATE = 09/09/1900] OR [FIRSTTREATDATE = 09/09/1900]


QPI 3 – Multi-Disciplinary Team Meeting (MDT)

QPI Title: Patients with head and neck cancer should be discussed by a multi-disciplinary team before definitive treatment.

Description: Proportion of patients with head and neck cancer who are discussed at MDT meeting before definitive treatment.

Numerator

Number of patients with head and neck cancer discussed at the MDT before definitive treatment.

Date Discussed by Care Team (MDT) not coded as not applicable AND Date Discussed by Care Team (MDT) less than or equal to Date of Definitive Treatment OR Date of Definitive Treatment equal to not applicable

[MDTDATE <> 10/10/1900] AND ([MDTDATE ≤ DEFTREATDATE] OR [DEFTREATDATE = 10/10/1900])

Denominator

All patients with head and neck cancer (excluding patients who died before first treatment and patients who undergo diagnostic excision biopsy as the definitive surgery). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND ‘Site of Origin of Primary Tumour’ coded as head and neck cancer; AND ‘Type of First Treatment not coded as patient died before treatment; AND ‘Intent of Definitive Surgery’ not coded as diagnostic excision biopsy only. (( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1])) AND [FIRSTTREATTYPE <> 94] AND [OPINTENT <> 03]

Not recorded for numerator

Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MDTDATE = 09/09/1900] OR [DEFTREATDATE = 09/09/1900]

Not recorded for exclusion

Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [FIRSTTREATTYPE = 99] OR [OPINTENT = 99]




QPI 4 – Smoking Cessation

QPI Title:

Patients with head and neck cancer who smoke should be offered referral to smoking cessation before first treatment.

Description:

Proportion of patients with head and neck cancer who smoke who are offered referral to smoking cessation before first treatment.

Numerator Number of patients with head and neck cancer who smoke who are offered referral to smoking cessation before first treatment. Smoking Cessation coded as Yes; and Date Offered Referral for Smoking Cessation coded as before Date of First Cancer Treatment or Date of First Cancer Treatment coded as inapplicable. [SMOKCESS=01] AND [SMOKCENDATE < FIRSTTREATDATE] OR [FIRSTTREATDATE = 10/10/1900]

Denominator All patients with head and neck cancer who smoke. (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; and Smoking coded as Yes

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [SMOKE = 01]

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [SMOKCESS = 99] OR [SMOKCENDATE = 09/09/1900] OR [FIRSTTREATDATE = 09/09/1900]

Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. N/A


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X] OR [SMOKE = 99]


QPI 5 – Oral and Dental Rehabilitation Plan

QPI Title:

Patients whose head and neck cancer treatment may affect oral and dental appearance and function should have an assessment co-ordinated by a Consultant in Restorative Dentistry before initiation of treatment.

Description:

Proportion of patients with head and neck cancer deemed in need of an oral and dental rehabilitation plan who have an assessment before initiation of treatment. Please note: The specifications of this QPI are separated to ensure clear measurement of the following:

i) Patients in whom the decision for requiring pre-treatment assessmenta has been made jointly by Consultants in

Restorative Dentistry and the MDT; and ii) Patients who require pre-treatment assessment that have this carried out before initiation of treatment.

Numerator (i)

Number of patients with head and neck cancer undergoing active treatment in whom the decision for requiring pre-treatment assessment has been made jointly by Consultants in Restorative Dentistry and the MDT. Oral Assessment Required coded as Yes or No [ORALREQ = 01 or 02]

Denominator (i)

All patients with head and neck cancer undergoing active treatmentb. (Excluding patients who have T1/T1a/T1b /T2/N0 Larynx

Cancer).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer, but not Site of Origin of Primary Tumour {Cancer} coded as Larynx Cancer and TNM Tumour Classification (Final) {Head and Neck Cancer} coded as T1 or T1a or T1b or T2 and TNM Nodal Classification (Final) {Head and Neck Cancer} coded as N0; and Type of First Cancer Treatment coded as surgery, radiotherapy, chemotherapy or chemoradiotherapy.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR C13 OR C14.0 OR C14.8 OR C30 OR C31 OR C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND NOT ( [SITE = C32.0 OR C32.0A OR C32.0B OR C32.0C OR C32.1 OR C32.1A OR C32.1B OR C32.1D OR C32.1E OR C32.2 OR C32.3 OR C32.3A OR C32.3A2 OR C32.3B OR C32.3C OR C32.8 OR C32.9 AND CT = T1 OR T1a OR T1b OR T2 AND CN = N0] AND [FIRSTTREATTYPE = 1 OR 2 OR 3 OR 15])

Numerator (ii)

Number of patients with head and neck cancer who are identified as requiring pre-treatment assessment that have assessment carried out before initiation of treatment.

a This specification measures whether a joint decision on the requirement for pre-treatment assessment has been agreed regardless of the outcome i.e. whether pre-

treatment assessment is required or not. b Active treatment is defined as surgery, radiotherapy, chemotherapy or chemoradiotherapy.


Date of Oral Assessment (Pre-treatment) coded as before or equal to Date of First Cancer Treatment or Date of First Cancer Treatment coded as inapplicable; and Date of Oral Assessment (Pre-treatment) not coded as Not applicable.

([DENSCREEN ≤ FIRSTTREATDATE] OR [FIRSTTREATDATE = 10/10/1900]) AND [DENSCREEN <> 10/10/1900]

Denominator (ii)

All patients with head and neck cancer who are identified by all relevant members of the MDT as requiring pre-treatment assessment. (Excluding patients who have T1/T1a/T1b/T2/N0 Larynx Cancer).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer, but not Site of Origin of Primary Tumour {Cancer} coded as Larynx Cancer and TNM Tumour Classification (Final) {Head and Neck Cancer} coded as T1 or T1a or T1b or T2 and TNM Nodal Classification (Final) {Head and Neck Cancer} coded as N0; and Oral Assessment Required coded as Yes.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR C13 OR C14.0 OR C14.8 OR C30 OR C31 OR C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND NOT ( [SITE = C32.0 OR C32.0A OR C32.0B OR C32.0C OR C32.1 OR C32.1A OR C32.1B OR C32.1D OR C32.1E OR C32.2 OR C32.3 OR C32.3A OR C32.3A2 OR C32.3B OR C32.3C OR C32.8 OR C32.9 AND CT = T1 OR T1a OR T1b OR T2 AND CN = N0] AND [ORALREQ = 01])


(i) [ORALREQ = 99] (ii) [DENSCREEN=09/09/1900] OR [FIRSTTREATDATE=09/09/1900]


(i) And (ii) [SITE = C99.X] OR [CT = 99] OR [CN = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard

(i) [SITE = C99.X] OR [FIRSTTREATTYPE = 99]

(ii) [SITE = C99.X] OR [ORALREQ = 99]


QPI 6 – Nutritional Screening

QPI Title:

Patients with head and neck cancer should undergo nutritional screening before first treatment.

Description:

(i) Proportion of patients with head and neck cancer who undergo nutritional screening with the Malnutrition Universal Screening Tool (MUST) before first treatment.

Numerator

Number of patients with head and neck cancer who undergo nutritional screening with the Malnutrition Universal Screening Tool before first treatment. Nutritional Screening (at Diagnosis) coded as Yes; and Date of Nutritional Screening coded as before or equal to Date of First Cancer Treatment or Date of First Cancer Treatment coded as inapplicable [NUTSCREEN = 01] AND [NUTSCREEN <> 10/10/1900 OR 09/09/1900] AND [NUTSCREENDATE ≤ FIRSTTREATDATE] OR [FIRSTTREATDATE = 10/10/1900]

Denominator

All patients with head and neck cancer. (No exclusions) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR -C13 OR C14.0 OR C14.8 OR C30 OR C31 OR -C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) )

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [NUTSCREEN = 99] OR [NUTSCREENDATE = 09/09/1900] OR [FIRSTTREATDATE = 09/09/1900]





QPI 7 – Specialist Speech and Language Therapist Access

QPI Title:

Patients with oral, pharyngeal or laryngeal cancer should be seen by a Specialist Speech and Language Therapist (SLT) before treatment to assess voice, speech and swallowing.

Description:

Proportion of patients with oral, pharyngeal or laryngeal cancer undergoing treatment with curative intent who are seen by a Specialist SLT before treatment.

Numerator

Number of patients with oral, pharyngeal or laryngeal cancer undergoing treatment with curative intent who are seen by a Specialist SLT before treatment. Date of Specialist Speech and Language Therapist Access not coded as Not performed; AND Intent of Definitive Surgery coded as curative AND Date of Specialist Speech and Language Therapist Access before or equal to Date of Definitive Surgery OR Radiotherapy Course Type {Head and Neck Cancer} coded as Radical or Chemoradiotherapy AND Date of Specialist Speech and Language Therapist Access before or equal to Date Treatment Started (Radiotherapy) {Head and Neck Cancer} SLTDATE <> 10/10/1900] AND (([OPINTENT = 01] AND [SLTDATE ≤ SURGDATE]) OR ([RCOURSETYPE1 OR RCOURSETYPE2 = 2 or 6] AND [SLTDATE ≤ RSTARTDATE1-2]))

Denominator All patients with oral, pharyngeal or laryngeal cancer undergoing treatment with curative intent. (Excluding patients who refuse assessment).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as oral, pharyngeal or laryngeal cancer; AND Intent of Definitive Surgery coded as Curative; OR Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Radical or Chemoradiotherapy; AND Specialist Speech and Language Therapist Access not coded as Patient declined.

[SITE = C00.3 OR C00.4 OR C00.5 OR C01.X OR C02 OR C03 OR C04 OR C05 OR -C06 OR C09 OR C10 OR C11 OR C12 OR -C13 OR C14.0 OR C14.8 OR C32.0 OR C32.0A OR C32.0B OR C32.0C OR C32.1 OR C32.1A OR C32.1B OR C32.1D OR C32.1E OR C32.2 OR C32.3 OR C32.3A OR C32.3A2 OR C32.3B OR C32.3C OR C32.8 OR C32.9] AND [OPINTENT = 01] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 2 or 6] AND [SLTASSESS <> 95]


[SLTDATE = 09/09/1900] OR [SURGDATE = 09/09/1900] OR [RSTARTDATE1 OR RSTARTDATE2 = 09/09/1900]


[SLTASSESS = 99]



Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X] OR [OPINTENT = 99] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 99]


QPI 8 – Surgical Margins

QPI Title:

Patients with head and neck cancer undergoing open surgical resection with curative intent should have their tumour adequately excised.

Description: Proportion of patients with squamous cell carcinoma of the oral cavity, larynx or pharynx with final excision margins of less than 1mm after open surgical resection with curative intent.

Numerator

Number of patients with squamous cell carcinoma of the oral cavity, larynx or pharynx who undergo open surgical resection with curative intent with final excision margins of less than 1mm (on pathology report).

Surgical Margins coded as ‘<1mm’.

[SURGMARG = 03]

Denominator

All patients with squamous cell carcinoma of the oral cavity, larynx or pharynx who undergo open surgical resection with curative intent. (Excluding patients with naso-pharyngeal cancer and patients with posterior pharyngeal wall cancer).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour coded as Squamous Cell Carcinoma; AND Site of Origin of Primary Tumour {Cancer} coded as oral cavity, larynx or pharynx; AND Definitive Operative Procedure {Head and Neck Cancer} not coded as Microlaryngoscopy-laser removal lesion or Microlaryngoscopy-cold removal lesion or Endoscopic Destruction of Lesion of Larynx or Endoscopic partial laryngectomy or Laser excision lesion hypopharynx/oropharynx or Laser excision lesion nasopharynx; and Intent of Surgery coded as Curative and Site of Origin of Primary Tumour {Cancer} not coded as Posterior wall of oropharynx or Posterior wall of hypopharynx.

[MORPHOL = 8051/3 OR 8052/3 OR 8070/3 OR 8071/3 OR 8072/3 OR 8073/3 OR 8074/3 OR 8075/3] AND [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C09 OR C10 OR C12 OR C13 OR C14.0 OR C14.8 OR C32] AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 OR OPCODE5 OR OPCODE6 OR OPCODE7 OR OPCODE8 OR OPCODE9 <> E34.1 OR 34.2 OR E35.3 OR E35.6 OR Y08.2] AND [OPINTENT = 01] AND [SITE <> C10.3 or C13.2].

Not recorded for numerator

Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [SURGMARG = 99]

Not recorded for exclusion

Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. NB Patients not recorded for SITE are excluded from the denominator.



Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [MORPHOL = 9999/9] OR [SITE = C99.0X] OR [OPCODE1 = 99] OR [OPINTENT = 99]


QPI 9 - Intensity Modulated Radiotherapy (IMRT)

QPI Title:

Patients with head and neck cancer undergoing radiotherapy should receive intensity modulated radiotherapy (IMRT).

Description:

Proportion of patients with head and neck cancer undergoing radiotherapy who receive IMRT.

Numerator

Number of patients with head and neck cancer undergoing radiotherapy who receive IMRT.

Intensity-Modulated Radiation Therapy (IMRT) coded as Yes

[IMRT = 01]

Denominator

All patients with head and neck cancer undergoing radiotherapy. (Excluding patients undergoing palliative radiotherapy care and patients with T1/T1a/T1b/T2/N0 larynx cancer).

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; and Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Adjuvant, Radical, Neo-adjuvant or chemoradiotherapy; and not Site of Origin of Primary Tumour {Cancer} coded as Larynx Cancer and TNM Tumour Classification (Final) {Head and Neck Cancer} coded as T1 or T1a or T1b or T2 and TNM Nodal Classification (Final) {Head and Neck Cancer} coded as N0.

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C07 OR C08 OR C09 OR C10 OR C11 OR C12 OR -C13 OR C14.0 OR C14.8 OR C30 OR C 31 OR C32 OR C76] OR ( [SITE = C41.0 OR C41.1] ) AND [RCOURSETYPE1 OR RCOURSETYPE2 = 01 OR 02 OR 04 OR 06] AND NOT ( [SITE = C32.0 OR C32.0A OR C32.0B OR C32.0C OR C32.1 OR C32.1A OR C32.1B OR C32.1D OR C32.1E OR C32.2 OR C32.3 OR C32.3A OR C32.3A2 OR C32.3B OR C32.3C OR C32.8 OR C32.9 AND CT = T1 OR T1a OR T1b OR T2 AND CN = N0] )

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [IMRT = 99]

Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. NB Patients not recorded for RCOURSETYPE are excluded from the denominator. OR [SITE = 99 AND CT = 99 AND CN = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = 99] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 99]


QPI 10 - Post Operative Chemoradiotherapy

QPI Title:

Patients with squamous cell carcinoma of the oral cavity, larynx or pharynx with nodal extracapsular spread and/or involved margins (<1mm) following surgical resection should receive chemoradiation.

Description: Proportion of patients with squamous cell carcinoma of the oral cavity, larynx or pharynx with nodal extracapsular spread and/or involved margins (<1mm) following surgical resection who receive chemoradiation.

Numerator

Number of patients with squamous cell carcinoma of the oral cavity, larynx or pharynx with nodal extracapsular spread and/or involved margins (<1mm) following surgical resection who receive chemoradiation.

Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Chemoradiotherapy; and Type of Systemic Anti-Cancer Therapy (SACT) 1-2 {Head and Neck Cancer} coded as Chemoradiotherapy

[RCOURSETYPE1 OR RCOURSETYPE2 = 06] AND [CHEMTYPE1 OR CHEMTYPE2 = 05]

Denominator

All patients with squamous cell carcinoma of the oral cavity, larynx or pharynx with nodal extracapsular spread and/or involved margins (<1mm) following surgical resection. (Excluding patients with performance status 2, 3 or 4, patients with naso-pharyngeal cancer and patients with oral (lip) cancer)

Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour coded as Squamous Cell Carcinoma; AND Site of Origin of Primary Tumour {Cancer} coded as oral cavity, larynx or pharynx; Extracapsular Spread coded as Yes or Surgical Margins coded as <1mm; AND Definitive Operative Procedure {Head and Neck Cancer} coded as surgical resection; AND WHO/ECOG Performance Status not coded as 2 or 3 or 4.

[MORPHOL = 8051/3 OR 8052/3 OR 8070/3 OR 8071/3 OR 8072/3 OR 8073/3 OR 8074/3 OR 8075/3] AND [SITE = C01 OR C02 OR C03 OR C04 OR C05 OR C06 OR C09 OR C10 OR C12 OR C13 OR C14.0 OR C14.8 OR C32] AND ( [EXCAPSPREAD = 01] OR [SURGMARG = 03] ) AND [OPCODE1 OR OPCODE2 OR OPCODE3 OR OPCODE4 OR OPCODE5 OR OPCODE6 OR OPCODE7 OR OPCODE8 OR OPCODE9 = E01.1 OR E01.8 OR E03.2 OR E04.3 OR E14.8 OR E19.1 OR E19.2 OR E23.1 OR E24.1 OR E24.2 OR E29.1 OR E29.2 OR E29.3 OR E29.4 OR E29.6 OR E30.1 OR E30.2 OR E34.2 OR E35.6 OR E39.1 OR E43.1 OR F01.1 OR F01.8 OR F02.1 OR F20.2 OR F22.1 OR F22.2 OR F23.1 OR F28.1 OR F32.4 OR F32.8 OR F34.1 OR F34.2 OR F34.3 OR F34.4 OR F34.9 OR F38.1 OR F38.2 OR F44.1 OR F44.2 OR F44.3 OR F44.4 OR F44.5 OR F45.1 OR F45.2 OR F45.3 OR F45.4 OR G02.1 OR V06.8 OR V07.2 OR V14.1 OR V14.2 OR V14.3 OR V14.4] AND [PSTATUS <> 2 or 3 or 4]

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [RCOURSETYPE1 OR RCOURSETYPE2 = 99] OR [CHEMTYPE1 OR CHEMTYPE2 = 99]

Not recorded for exclusion Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. NB Patients not recorded for SITE are excluded from the denominator



Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [MORPHOL = 9999/9] OR [SITE = C99.X] OR [EXCAPSPREAD = 99] OR [SURGMARG = 99] OR [OPCODE1 = 99] OR [PSTATUS = 9]


QPI 11 – 30 and 90 Day Mortality

QPI Title:

30 and 90 day mortality after curative treatment for Head and Neck Cancer.

Description:

Proportion of patients with head and neck cancer who die within 30 or 90 days of curative treatment.

Numerator (i)

Number of patients with head and neck cancer who undergo curative treatment who die within 30 days of treatment. Date of Death is not coded as inapplicable and is within 30 days of date of curative treatment [either – SURGDATE / RCOMPDATE1-2 / Surgery

[DOD – SURGDATE ≤ 30] AND [DOD <> 10/10/1900] Radical Radiotherapy

[DOD – RCOMPDATE1-2 ≤ 30] AND [DOD <> 10/10/1900] Chemoradiotherapy

( [DOD – RCOMPDATE1-2 ≤ 30] OR [DOD – CHEMENDATE1-2 ≤ 30] ) AND [DOD <> 10/10/1900]

Numerator (ii)

Number of patients with head and neck cancer who undergo curative treatment who die within 90 days of treatment. Date of Death is not coded as inapplicable and is within 90 days of date of curative treatment [either – SURGDATE / RCOMPDATE1-2 / Surgery

[DOD – SURGDATE ≤ 90] AND [DOD <> 10/10/1900] Radical Radiotherapy

[DOD – RCOMPDATE1-2 ≤ 90] AND [DOD <> 10/10/1900] Chemoradiotherapy

( [DOD – RCOMPDATE1-2 ≤ 90] OR [DOD – CHEMENDATE1-2 ≤ 90] ) AND [DOD <> 10/10/1900]


Denominator (i) and (ii)

All patients with head and neck cancer who undergo curative treatment. (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; and Site of Origin of Primary Tumour {Cancer} coded as Head or Neck Cancer; and curative treatment for each treatment type [either – OPINTENT / RCOURSETYPE1-2 / CHEMTYPE1-2 Surgery Intent of Surgery coded as Curative

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [OPINTENT = 01]

Radical Radiotherapy

Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Radical

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [RCOURSETYPE1 OR RCOURSETYPE2 = 02]

Chemoradiotherapy

Radiotherapy Course Type {Head and Neck Cancer} (1-2) coded as Chemoradiotherapy; and Type of Systemic Anti-Cancer Therapy (SACT) 1-2 {Head and Neck Cancer} coded as Chemoradiotherapy

( ( [SITE = C00.3 OR C00.4 OR C00.5 OR C01-C13 OR C14.0 OR C14.8 OR C30-C32 OR C76] OR ( [SITE = C41.0 OR C41.1]) ) AND [RCOURSETYPE1 OR RCOURSETYPE2 = 06] AND [CHEMTYPE1 OR CHEMTYPE2 = 05]

Not recorded for numerator Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target Surgery [DOD = 09/09/1900] OR [SURGDATE = 09/09/1900] Radical Radiotherapy [DOD = 09/09/1900] OR [RCOMPDATE1 OR RCOMPDATE2 = 09/09/1900]


Chemoradiotherapy [DOD = 09/09/1900] OR [RCOMPDATE1 OR RCOMPDATE2 = 09/09/1900] OR [CHEMENDATE1 OR CHEMENDATE2 = 09/09/1900]



Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard Surgery [SITE = C99.X] OR [OPINTENT = 99] Radical Radiotherapy [SITE = C99.X] OR [RCOURSETYPE1 OR RCOURSETYPE2 = 99] Chemoradiotherapy [SITE = C99.X] OR [RCOURSETYPE1 OT RCOURSETYPE2 = 99] OR [CHEMTYPE1 OR CHEMTYPE2 = 99]

Head and Neck Cancer - ISD Scotland · 2 QPI Title Amend to‘Patients with head and neck cancer...

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