Cancer

Cancer - Rationale for Inclusion of Indicator Set
Cancer is a clinical priority in all four countries.

It is recognised that the principal active management of cancers occurs in the secondary care setting.

General practitioners often have a key role in the referral and subsequently in providing a support role and in ensuring that care is appropriately co-ordinated.

This indicator set is not evidence-based.

Cancer Indicator 1
The practice can produce a register of all cancer patients diagnosed after 1 April 2003

Cancer 1.1 Rationale
A register is a prerequisite for ensuring follow-up of patients with cancer. The register can be developed prospectively as the intention is to ensure appropriate care and follow-up for patients with a diagnosis of cancer. For the purposes of the register all cancers should be included except non-melanomatous skin lesions.

Cancer 1.2 Preferred Coding

Cancer 1.3 Reporting and Verification
The practice reports the number of patients added to its cancer register in the last twelve months and the number of patients added to its cancer register in the last twelve as a proportion of total list size.

Verification - PCOs may compare the expected prevalence of new cases with the reported prevalence.

Cancer Indicator 2
The percentage of patients with cancer diagnosed from 1 April 2003 with a review by the practice recorded within six months of confirmed diagnosis. This should include an assessment of support needs, if any, and a review of co-ordination arrangements with secondary care

Cancer 2.1 Rationale
Most general practitioners will see patients with a new cancer diagnosis following assessment and management in a secondary or tertiary care setting. The purpose of the review is usually to provide support to the patient and to ensure that follow-up arrangements between the GP and the secondary care service are clear both to the patient and the GP.

Cancer 2.2 Preferred Coding
Cancer diagnosis discussed 8CL0

Cancer 2.3 Reporting and Verification
The IT solution for this indicator is not straightforward. This is because it is difficult to tie the date of review to the date of diagnosis in computer searches.

Practices could search for patients who have been added to the register between 6 months and 12 months previously and undertake a manual search of notes to ascertain if a cancer review has been undertaken.

The alternative pragmatic solution which has been agreed is to undertake a search for those added to the cancer register between 6 and 12 months ago who also have an 8CL0 coding in the last 12 months. Although this search is not identical to the indicator it will identify a cohort of cancer patients and identify if a cancer review has taken place up to twelve months after diagnosis dependent on when the diagnosis was made.

Verification may involve randomly selecting a number of case records of patients in which the review has been recorded as taking place to confirm that the two components have been undertaken and recorded.