Oncology treatment patterns in the South Island
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Transcript of Oncology treatment patterns in the South Island
Oncology Treatment Patterns in the South
Island
Presenter: Dr Shaun CostelloCo-authors: Dr Ursula Jewell and Di Riley, SCN Manager
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Conflicts of Interest
Travel and conference Support from Pharmaceutical Company's
Honoraria for Pharma and Oncology Tech Advisory Boards
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Why are we here?
NZ – Aus All Cancer Death Rates (1990 onwards)
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SCN – Aims & Objectives
To support the improvement in patient outcomes, through reducing the impact and incidence of cancer, reducing inequalities and improving the quality of cancer services
Principle Objectives
Through integrated working and shared visionPatient Management / Information Systems Infrastructure
Access to SI-wide Cancer Intelligence
Understanding Service and Clinical Outcomes
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Focus on awareness and early diagnosis4
Addressing inequalities and support for the patient and public5
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SCN – 5 Principles
To support the improvement in patient outcomes, through reducing the impact and incidence of cancer, reducing inequalities and improving the quality of cancer services
Principle Objectives
The ‘HOW’?Capture patient-level data as part of routine patient care
Creating a shared SI-wide patient-level data repository
Conduct analyses to review and understand patterns of care
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Use information to drive change and improve care and outcomes4
Maximise access to & use of data available e.g. audit/research5
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1) Capture patient-level data as part of routine patient care:
South Island MOSAIQ roll out
Christchurch Hospital, CDHB
Nelson Hospital, NMDHB
Ashburton Hospital, CDHB
Grey Hospital,WCDHB
Oamaru Hospital, SDHB
InvercargillKew Hospital, SDHB
Dunstan Hospital, Clyde, SDHB
Clutha Health First Hospital, Balclutha, SDHB
Dunedin Hospital, SDHB
Timaru Hospital, SCDHB
Wairau Hospital, NMDHB
Planned utilisation of CDHB’s MOSAIQ system post PICS implementation
Utilisation of CDHB’s MOSAIQ system
Utilisation SDHB’s MOSAIQ system
Access to SDHB’s MOSAIQ system
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MOSAIQ is a front-line clinical system, used in oncology
MOSAIQ interfaces with the PAS to provide the following functions:
• NHI check
• Mortality check
• Transmission of patient demographic information into MOSAIQ
• Transmission of patient bookings back into PAS
• Electronic referral process (from PAS to MOSAIQ and vice versa)
• Patient-related and treatment information not isolated from
general electronic record
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2) Creating a shared SI-wide patient-level Data Repository:
METRIQ implementation
• Each data source is huge valueBUT• Linked together they are enormously powerful
METRIQ
Blue = live data importsYellow = in planning
BlueYellow
FCT
Deaths
MDM
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3) Conduct analyses to Review & Understand Patterns of Care
• Identify a suite of ‘key questions’– Keep focused on them– Involve all SCN Partners & experts
• Understand data available– Including quality & timeliness– To have ‘fit data’ need to exercise it….– Publish & polish approach
• Avoid extra data collection• Use recognised analytical techniques
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4) Use Information to Drive Change and Improve Care & Outcomes:
UK COSD example
• Report findings promptly with interpretation, the ‘so what’ approach……..
• Discuss, debate, share, consult, etc., etc.,
• Use dashboards, profiles, • Use single or multiple data sources/analyses
together – far more powerful
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5) Maximise access to and Use of Data Available, e.g. Audit/Research
SICCIS Data request and review group and guidelines
• Collect once, use multiple times
• Test data accuracy, completeness, and timeliness
– UoO summer student study in 2014/2015 showed insufficient information in METRIQ to compare differences in careplans
– Treatment details captured in METRIQ (prospectively and retrospectively) since February 2015
• Provide data quality assurance
• Data governance and guidelines
• Make data and information available to others
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METRIQ patient cohort as of 31/07/2015
METRIQ currently captures all patients who have an oncology appointment
(Medical and/or Radiation Oncology) in
• CDHB
• WCDHB
• SCDHB
• SDHB
• Both South Island private Cancer Centres (St. George’s and Mercey)
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METRIQ data items as of 24/09/2014
Demographics Diagnostics Comorbidity, 2ndary Dx Treatment Outcome
NHI Primary Site Comorbidity 1 Radiation - Location of Radiation Quality of survival (performance status)
Gender Primary Site Text Comorbidity 2 Radiation - Number of Treatments to Volume Vital Status
Name First Morph-Type & Behaviour ICD-O-3 Comorbidity 3 Radiation - Regional Dose (CGY)
Name Middle Laterality Comorbidity 4 Radiation - Regional Radiation Modality
Name Last Lymph-vascular invasion Comorbidity 5 Radiation - Subsequent Radiation Key datesName Prefix TNM-clin T Comorbidity 6 Radiation - Treatment Volume Birth DateName Suffix TNM-clin N Comorbidity 7 Radiation Beam Text remarks Date of 1st ContactName Maiden TNM-clin M Comorbidity 8 Height (cm) Date of DiagnosisMarital Status TNM-clin stage group Comorbidity 9 Weight (kg) Date of last contactTelephone TNM-path T Comorbidity 10 Chemotherapy - Treatment Date Date Treatment StartedText Occupation TNM-path N ICD-10 Secondary Diagnosis 1 Chemotherapy - Treatment Summary Date Treatment Ended
Text Remarks TNM-path M ICD-10 Secondary Diagnosis 2 Chemotherapy - Treatment Summary Date Subsequent Treatment started
Birthplace State TNM-path stage group ICD-10 Secondary Diagnosis 3 Chemotherapy Treatment Text Date of DeathAddress street TNM Edition Number ICD-10 Secondary Diagnosis 4 Hormone Therapy Treatment TextAddress 2nd line CS site specific factor ICD-10 Secondary Diagnosis 5 Hormone Therapy - Treatment Date
Address City CS tumour size ICD-10 Secondary Diagnosis 6 Hormone Therapy - Treatment Summary
Address Postal Code Grade ICD-10 Secondary Diagnosis 7 BRM - Treatment DateAddress State Regional nodes Examined ICD-10 Secondary Diagnosis 8 BRM - Treatment SummaryCounty Current Regional nodes Positive ICD-10 Secondary Diagnosis 9 BRM Therapy Treatment TextEthnicity 1 Site of distant metastasis 1 ICD-10 Secondary Diagnosis 10 Subsequent Course ChemotherapyEthnicity 2 Site of distant metastasis 2 Subsequent Course Hormone TherapyEthnicity 3 Site of distant metastasis 3 Subsequent Course BRMEthnicity 4 Diagnostic Confirmation Treatment HospitalEthnicity 5Spanish Hispanic
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What METRIQ data items actually look like…
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South Island Cancer Registrations in NZCR and METRIQ
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Overall stage group distribution for most common cancers in SI public tertiary centres Aug 2014 – Jul 2015
Overall stage group
Tertiary centre
Cancer site
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Treatment modalities for most common cancersin SI public tertiary centres Aug 2014 – Jul 2015
Tertiary centre
Cancer site
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Comparison of treatment modalities for Lung Cancer patients diagnosed Aug 2014 – Jul 2015
Overall stage group
SI Public Tertiary Centres
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Example of Radiation Regional Dose recordings for Lung Cancer patients diagnosed Aug 2014 – Jul 2015
Regional Dose in cGY
Overall stage group
SI Public Tertiary Centres
Number of records
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Goal for METRIQ: National/International Benchmarking
• > 2M cases (US, 1985 to present)
• data includes detailed tumour descriptions, treatments (radiation, hormonal, chemotherapy, biological and surgical), and survival outcomes in both outpatient and inpatient settings
• pre-validated source of timely, longitudinal cancer data for population-based research
Top 10 Cancers in NODA for 2007
First Course of Treatment for Breast Cancer by AJCC stage
5-Year Survival Rates for Breast Cancer by stage 2003-2007
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Conclusion and next steps
• METRIQ offers the opportunity to collate ‘real-time’ clinical data
• Accuracy of information is dependant on
– data entry in the clinical setting
– Clinical input and regional agreement on definitions for MOSAIQ data fields and translation tables
• Appraisal of METRIQ in light of the new Cancer IT strategy
• Audit accuracy, completeness, and timeliness
• Add further data sources to achieve complete regional view of cancer
• Make data and information available to others
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The Ascent of Knowledge Mountain!
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CDHBCDHB OncologyDrew WinterAndy SavinRob HallinanIain WardBridget RobinsonScott BabingtonDavid GibbsNigel MillerCDHB IT teamAaron PenmanChris Dever
It’s all team work… Thank you!
SDHBSDHB OncologyNatasha RobinsonTherese DuncanLynda DaggSimon PointerChris JacksonBlair McLarenShaun CostelloAndrew BowersSDHB IT teamSapna BoyceJohn Simpson
SCDHBBelinda DoreAnna MacDonald
WCDHBMary MarrAndrea ReilleyJenny Boote
NMDHBRosey WilsonPhil Gibbs
St George’s Cancer Care CentreViv AliSt George’s IT team