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Improving Cancer Outcomes in Camden

Improving Cancer Outcomes in Camden. Dr Lucia Grun 19 May 2014. Why does early diagnosis matter?. Five year relative survival rates. Five year survival of common cancers diagnosed Early versus late. Directly standardised mortality rate aged under 75 for all cancers, Camden, 1993-2011.

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Improving Cancer Outcomes in Camden

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  1. Improving Cancer Outcomes in Camden Dr Lucia Grun 19 May 2014

  2. Why does early diagnosis matter?

  3. Five year relative survival rates

  4. Five year survival of common cancers diagnosed • Early versus late

  5. Directly standardised mortality rate aged under 75 for all cancers, Camden, 1993-2011 • Source: Health and Social Care Information Centre, 2013, NB data for 2009-11 are provisional at the time of publication.

  6. Camden-specific statistics… • The reduction in Camden’s cancer rates has been faster over the past 10 years (27%) than England (22%) or London (25%) • May relate to greater than average reduction in numbers of smokers in Camden • Camden also has a significantly higher proportion of cancers diagnosed at stage 4 (late) compared to the London average Camden Joint Strategic Needs Assessment 2013, Camden Council http://www.camden.gov.uk/ccm/content/social-care-and-health/health-in-camden/joint-strategic-needs-assessment-2012/chapter-16-cancer.en?page=3

  7. Quick view of Camden’s Cancer Profile • A young population - 9% of Camden is 65+ (England mean of 15.8%) • Screening coverage is lower than England

  8. Quick view of Camden’s Cancer Profile • Number of TWW with a cancer diagnosis – 63 (3.8% - lowest proportion in the UK) • Percentage of new cancer cases treated which were not TWW referrals – 67 (51.5%) • Screening? Incidental finding? Routine referral? A&E?

  9. Lots of problems in one consultation Pressure on appointments Previous experience Multiple guidelines Primary Care Co-morbidities in patients Keeping up to date Lack of co-ordination across pathways Difficulties of access SecondaryCare PublicAwareness Fear Pressure on appointments Lack of knowledge Previous experience Shortage of diagnostic appointments Cultural Issues No urgent appointment pathway Perceived barriers to Primary Care Lack of direct access to diagnostics Fatalism

  10. Pressures on Primary Care

  11. National Patient Experience Survey for all cancers Question 64: Practice staff definitely did everything they could to support patient Data Source: National Cancer Patient Experience survey

  12. Primary Care Education Package • Aligned with the Long Term Conditions Locally Commissioned Scheme (LCS) • Part of CCG’s Long Term Conditions and Cancer programme priorities • Available to all practices in Camden • Includes • practice visits • education events • peer review meetings

  13. Improving Cancer Outcomes in Camden. • A project funded by Camden CCG and delivered by London Cancer.

  14. What we are offering • Practice visits from Cancer Research UK Facilitator • Upper and Lower GI clinical audit • Running a local awareness campaign • BMJ online learning tool • Macmillan Referral Styles Pilot

  15. 1. Practice visits from Cancer Research UK Facilitator • Visits are currently taking place across all practices • 17 practices have arranged visits between May and July • Opportunity to discuss GP profiles, cancer tools, sessions with practice staff • If you wish to have a visit, please see Carol Murphy, the Camden Primary Care Facilitator, carol.murphy@cancer.org.uk

  16. 2. Upper and Lower GI audit – background • 1st April 2012-31st March 2013 for patients diagnosed with an upper or lower GI cancer • A total of 175 patients were identified and audited in both primary and secondary care • Currently - 82 audit submissions have been received from 15 practices across Camden • Data for all patients were received back from the Royal Free and UCLH – allowing for a greater understanding of the entire patient pathway

  17. Upper and Lower GI audit – preliminary results (as of 15/05/2014) • Youngest patient was 42 years old • Oldest patient was 90 years old • Majority are male • Higher diagnoses made in 71-80 age group

  18. Contact with GP • High service users • Only 2 patients did not see their GP before diagnosis • Any interaction with primary care in 2 years before diagnosis (including home visits, telephone calls): • 0-10 interactions before diagnosis – 27 patients • 10-20 interactions before diagnosis – 28 patients • 20-30 interactions before diagnosis – 17 patients • 30+ interactions – 10 patients

  19. Most relevant symptoms in the Upper GI cases

  20. Most relevant symptoms in the Lower GI cases

  21. Routes to diagnosis • 2ww • 65% of patients were referred to secondary care through the 2ww • A&E • 20% of patients were diagnosed through A&E • Screening • 10% had abnormal screening test results leading to diagnosis • Other • 5% were diagnosed through other means such as incidental findings or routine referrals

  22. 3. Local awareness campaign – ‘the small c’

  23. Who are we targeting in Camden? • 1. Over 50s population • 4 most deprived wards of Camden (Cantelowes, Kilburn, Somers Town and St Pancras, Haverstock) • Led by Arsenal in the Community & Tottenham Hotspurs Foundation • 2. Bangladeshi population • Camden wide • Led by the Bengali Workers Association

  24. 4. BMJ OnExamination: Online learning tool for Camden GPs • An initial knowledge test. From this BMJ OnExamination will identify knowledge gaps which will inform the development of learning modules to target and improve knowledge in these specific areas • A programme of self assessment modules will be provided with relevant learning material based on knowledge test results • A post-test to confirm knowledge improvement by engaging with the self • assessment modules • Timescale: Over 18 – 24 months

  25. Benefits to you: • Atleast10 hours CPD on completion / Preparation for Appraisal • Improved knowledge in the early diagnosis and treatment of cancers • Assessment content is relevant to current GP practice & local guidelines • Assessments available anytime to fit in during surgery or work at your own speed at home • Revisit modules as often as you like for the duration of the programme • Benefits to Camden CCG: • Improved patient outcomes • Improved knowledge across key clinical areas, i.e. an improvement in earlier • cancer diagnosis rates and referrals

  26. 5. Macmillan Referral Styles - Recruiting now! • The project aims to deepen understanding of GP cancer referral behaviour by testing the value of a framework designed to identify differences in the way in which GPs refer • Provides a view of GP referral styles where the focus is on individual physicians; it is not a replication of ‘Routes to Diagnosis’ nor a cancer epidemiology study • Is based on a unique, bespoke dataset, combining real-world patient level data on cancer patients and non cancer 2 Week Wait referrals with detailed survey responses from the GPs participating in the study: • Survey responses from every treating GP give a unique insight into referral behavior, and data not available in standard sources

  27. Bowel Screening LCS (beginning in July 2014) • 1) Health promotion payments– displaying material • 2) Payment for letters - sending GP endorsement letters to all patients being invited for Bowel Cancer Screening • 3) Payment for follow up consultations - Follow-up consultations (either telephone or face-to-face) with patients who have not returned kit after 4 weeks • 4) Payment for increases in uptake - Payment for increases in uptake compared to 2013/14 baseline • 5) Administration payments - Entry of bowel screening results and other administration

  28. What is the CANDID STUDY? • Finding out what symptoms & examinations are best for predicting lung & bowel cancer. • Funded by National Institute for Health Research National School of Primary Care Research. • Multi-centred study coordinated from University of Southampton & led by Professor Paul Little. • What is involved for Practices? • Practices will identify 49 potential participants in 2 ways: • Opportunistically during consultations. • Database search & mail-out • GPs & Nurse Practitioners asked to: • Collect clinical information using a standardised form • Offer patient an optional blood/saliva sample & to complete a lifestyle questionnaire • Complete a notes review for each patient 2 years after recruitment (takes approx. 15 minutes) • Service Support Costs: • £49.61 per patient recruited plus an additional payment of £5.50 per study blood sample. • This amounts to approx. £2,430.00 for 49 patients • For more information please contact: • Eloise Radcliffe, London Co-ordinator: 020 7794 0500 x 36730 eloise.radcliffe@ucl.ac.uk

  29. Please stay in this room to hear about myeloma diagnosis and management with Dr Neil Rabin • Please follow Hannah to the next room for the session with Dr Andrew Millar on management of abdominal symptoms • There will be a refreshment break at 3:15pm

  30. See you at the next Education Event! • Friday 20th June: Diabetes • Wednesday 16th July: Heart Failure • Registration: • http://www.camdenccg.nhs.uk/gps/camden-gp-education-programme

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