Flashcards in cancer Deck (151)
what is the eurocare report and what did it show?
comparing 5 year cancer survival in patients across Europe ->UK performing less well
-Lower than european average for colorectal cancer mortality.
what are the potential causes of poor performance in the eurocare report? (4)
1. Differences in data collection (registries) -> rejected
2. Age differences ->but rates were age-standardised
3. Differences in stage at presentation, social class (↑affluent had ↑survival improvement, deprived have worse rates) + access to treatment.
4. Greater delay in pathway to diagnosis
what were the consequences and conclusions of EUROCARE-II report?
Despite methodological limitations, cancer survival in UK in 80s+90s one of worst in europe.
Expert advisory group to chief medical officer generated “Calman-Hine” report.
what were the recommendations of the Calman-Hine report? (7)
1. All patients should have access to uniformly high quality care.
2. Public and professional education, to recognise early symptoms.
3. Patients, families + carers should be given clear info re: treatment options + outcomes.
4. Cancer services should be patient-centred
5. 1° care to be CENTRAL to cancer care (1st time this had been suggested!!)
6. Psychosocial needs of carers + patients to be recognised ->also fairly new
7. Registration + monitoring of outcomes are to be essential
what are the solutions to the calman hine report findings?
3 levels of care
1. 1° care
2. Cancer Units Serving DGHs (district general hosps) - Treat common cancers, diagnostic procedures, common surgery, non-complex chemo
3. Cancer Centres – serving populations of >1m, Treating rare cancers, RTx + complex chemotherapy.
Also recognised ongoing importance of palliative care.
what is the purpose of organising care into 3 levels of care? (4)
1. Bring together commissioners (health authorities, CCGs), providers (GP surgery, community care, hospitals) and local authority + voluntary sectors
2. Helps to integrate aspects of care + deliver holistic package
3. Allows targeting of resources where needed most
4. Promotes alliance between providers
why is there an emphasis on the MDT?
Modern management involves many disciplines and allied health professionals, MDT streamlines and co-ordinates care so that it is not fragmented over several sites. ->BETTER OUTCOMES!
- Doubled NSCLC median survival
- increase outcomes of ovarian cancer, for patients managed by specialist teams (gynaecologist vs. non-gynaec)
what is the structure of the cancer MDT?
CORE: Medical staff (physician, oncologist, radiologist, histopathologist), Specialist nurse, MDT co-ordinator.
EXTENDED: Physio, dietician, palliative care, chaplain
what is the function of the MDT?
1. Discuss all new diagnoses at the site. Decide on management + inform 1° care of it
2. Designate specialist nurse to patient. Audit. Develop guidelines.
what are the advantages of concentrating specialist care into cancer centres?
1. Centres of excellence which have a very high level of expertise
2. Often needed only in most complex cases -> therefore inefficient to have this in all 3° centres
3. For a number of cancers, ↑ volume of surgical procedures -> ↑ outcomes. Better to have fewer centres with ↑ volume of cases.
what are the disadvantages of concentrating specialist care into cancer centres?
1. Possible –ve impact on provision of care in smaller hospitals
2. Challenging to provide accessible services to more geographically isolated areas
what are cancer networks?
-(cf MDT that produce local treatment guidelines) to be organisational model to implement the cancer plan. They drive cancer plan and cancer reform strategy.
•34 Cancer networks -> 12 Strategic clinical networks (SCNs) – cover not just cancer (include CVD, dementia, less staff – Apr 2013
•1° aim -> ↓ inequalities in the care of cancer
“Networks are to ensure that all commissioners and providers of cancer care, the voluntary sector and local authorities within the network work effectively together to deliver high quality care."
what ways is quality of cancer services measured at local and national levels?
• One of the few conditions which we have a population level registry!
• In UK we now have 4 cancer registries
• Responsible for registering ALL cancers occuring in geographical area.
• Prinicple aim is to establish incidence and survival over time, between demographics and social groups – can help ↓ inequality
• Also can be used to track efficacy of screening + primary prevention schemes.
o Can be used to change + improve schemes
• Allows comparison between regions – evaluate quality of care
• Evaluates impact of social + environmental factors ->inform means to ↓inequality
WHAT IS CANCER SURVIVAL + HOW IS IT MEASURED?
what is survival?
% of study population who are alive for a given period of time following diagnosis (usually 5 yrs)
what is relative survival?
estimate of number of patients expected to survive, calculated from national mortality data
what is observed survival?
actual number alive after specified time post-diagnosis
what is net cancer specific survival?
probability of surviving cancer in absence of other illness
what is crude probability of death?
probability of death from cancer in presence of other causes of death. Obtained from life expectancy tables/cause of death info.
describe the main issue with death rates and confounding?
Confounded massively by age. Two approaches to deal with it:
what are the 2 ways to deal with confounding with age and death rates?
describe the role of indirect standardisation in death rates and confounding?
How many deaths would we expect in age group? How many were there?
Observed/expected ratio = STANDARDISED MORTALITY RATE
•SMR = 100% = population experiences mortality rate similar to standard rate
•SMR > 100% = higher than standard rate
SMR < 100% = lower than standard rate
describe the role of direct standardisation in death rates and confounding?
Weighted avg of ‘stratum-specific rates’. Weights usually based on ‘standard population’
describe the structure of cancer care?
facilities, recources (both human and material), organisation
i.e. clinics, consultants, nurses, mammogram scanners, GPs
describe the measures of cancer outcome?
Results, changes in health status, PROMs (i.e. satisfaction)
i.e. mortality rate
describe the role of national cancer research network?
•Established by DoH in 2001 in response to need for integration of research and cancer care
•Supports prospective cancer trials + trials performed by charity
•AIM: ↑ speed, quality and integration of research to improve patient care
describe the role of the national cancer research institute?
•Est. 2001 to develop common plans for cancer research and to avoid unnecessary duplication of studies/effort.
• Invest in facilities + resources for research
•Maintain cancer research database and analyse new research.
•Develop research initiatives • Coordinate clinical trials for new drugs
what is an adverse event?
unintended event resulting from clinical care + causing patient harm, whether physical or psychological
o Serious ‘NEVER’ events, or non-serious.
what is a near miss?
events or omissions arising during clinical care fail to develop further (whether or not due to compensating action), thus preventing injury to patient.
oAlthough no harm comes, they do
show the potential!
give examples of never events?
•Wrong surgical site
•Retained instrument post-surgery
•Wrong admin route for chemo
•Inpatient suicide using collapsible rails
•Maternal death from post-partum haemorrhage after elective caesarian
•IV admin of conc. KCl