improving cancer outcomes in camden dr lucia grun 15 october 2014
TRANSCRIPT
Improving Cancer Outcomes in Camden
Dr Lucia Grun
15 October 2014
12:30 pm Registration and Lunch1:30 pm Introduction
Outcomes from Upper and Lower GI auditDr Lucia Grun
1:50 pm BMJ Cancer Learning ToolDr Matt Morgan
2:00pm Bowel Scope and Straight to Test DiagnosticsDr Ed Seward
2:30pm Consultant led case study discussions3:30 pm Refreshment Break
3:55pm Consultant led case study discussions continued
4:55 pm Feedback and Close
Why am I still standing here?
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International Cancer Benchmarking Partnership: 5 year relative survival, patients diagnosed 1995-2007:
Coleman et al, Lancet 2011
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International Cancer Benchmarking Partnership: 5 year relative survival, patients diagnosed 1995-2007: Coleman et
al, Lancet 2011
Five year relative survival rates
What we are offering
1. Practice visits from Cancer Research UK Facilitator
2. Upper and Lower GI clinical audit (results to follow)
3. Local awareness campaign
3. BMJ online learning tool
1. Practice visits from Cancer Research UK Facilitator
• Visits are currently taking place across Camden
• 25 practices have arranged visits between May and October
• 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, [email protected]
3. Local awareness campaign – ‘the small c’
2. Bangladeshi population
- Camden wide
- Grass root groups: Bengali Workers Association; Green Light Pharmacy
1. Over 50s population
- 4 most deprived wards of Camden (Cantelowes, Kilburn, Somers Town and St Pancras, Haverstock)
- Grass root groups: Abbey Community Centre, African Health Forum, North London Care, Tottenham in the Community
Who are we targeting in Camden?
Upper and Lower GI Audit
Patients in Camden diagnosed with
Upper and Lower GI cancer between
2011-2013
Patients Identified:
Lower: 143Upper: 39
Assessment and follow up
GP Practices contacted: 36
Questionnaires received:
Lower: 108Upper: 27
From: 30 practices
Analysis
Questionnaires Analysed:Lower: 104Upper: 22
Questionnaires Incomplete:
Lower: 4Upper: 5
Wrong form completed:
Lower: 6Upper: 2
Overview of process and final numbers
Route to diagnosisRoute Lower GI Upper GI
2WW 60 7
Routine referral 5 1
Screening 4 0
Other department 4 0
A + E 14 2
Private 2 2
Unclear 19 15
Upper GI – Number of comorbidities
None stated 1 2 3 4 5 6 70
1
2
3
4
5
6
No of co-morbidities
Upper GI – No of comorbidities by age group
0 1 2 3 4 5 6 740-49 1 150-59 1 160-69 1 3 2 2 170-79 1 1 180-89 1 2 1 190-99 1Total 1 0 4 5 5 4 1 2
Age No of Co-morbidities
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Upper GI Symptoms
Dyspepsia <6 weeks
Dyspepsia >6 weeks
Dysphagia
Chronic GI Bleeding
Progressive weight Loss
Persistent Vomiting
Iron Deficiency Anaemia
Epigastric mass
Suspicious Barium Meal
Upper abdominal Mass
Unexplained upper abdominal pain
Obstructive jaundice
Previous peptic ulcer >20yrs before
Known Barretts oesophagus
Known dysplasia atrophic gastritis
Known intestinal metaplasia
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes No Unknown
Upper GI Symptoms
Dyspepsia <6 weeks
Dyspepsia >6 weeks
Dysphagia
Chronic GI Bleeding
Progressive weight Loss
Persistent Vomiting
Iron Deficiency Anaemia
Epigastric mass
Suspicious Barium Meal
Upper abdominal Mass
Unexplained upper abdominal pain
Obstructive jaundice
Previous peptic ulcer >20yrs before
Known Barretts oesophagus
Known dysplasia atrophic gastritis
Known intestinal metaplasia
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes No Unknown
Progressive weight loss+/- Dysphagia
accounts for 60% of cohort in this audit
Lower GI – No of comorbidities
None stated 1 2 3 4 5 6 7 8 90
5
10
15
20
25
30
No of co-morbidities
Lower GI – No of comorbidities by age group
None stated 1 2 3 4 5 6 7 8 9
30-39 1 140-49 2 1 2 150-59 1 2 2 3 260-69 4 2 3 10 1 5 4 1 170-79 2 2 2 7 8 6 3 2 180-89 2 2 4 2 3 2 1 190-99 1 1 1 1Unknown 1Total 11 8 9 24 17 16 11 3 3 2
AgeNo of Co-morbidities
Lower GI Symptoms
Bleeding from back passage
Blood in stools
Change in bowel habit
Constipation
Nausea / Vomiting
Anaemia
Weight loss
Lump in back passage
Abdo Pain
Pain in back passage
Bloating
Inability to empty bowel
Mucus discharge
Faecal incontinance
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes No Unknown
Lower GI Symptoms
Bleeding from back passage
Blood in stools
Change in bowel habit
Constipation
Nausea / Vomiting
Anaemia
Weight loss
Lump in back passage
Abdo Pain
Pain in back passage
Bloating
Inability to empty bowel
Mucus discharge
Faecal incontinance
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Yes No Unknown
Change in Bowel Habit +/- Bleeding from back passage +/- Constipation+/- Abdominal Pain
accounts for 66% of cohort in this audit
Average number of appointments
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 290.0
5.0
10.0
15.0
20.0
25.0
30.0
Average no. of appointments by practice (Lower GI)
Av no of attendances in 2 years Camden average
No of comorbidities influences no of appointments
1 to 2 3 to 4 5 to 6 7 to 90.0
5.0
10.0
15.0
20.0
25.0
No. of comorbidities
Aver
age
no. o
f app
oint
men
ts
What can we do with these findings?
12:30 pm Registration and Lunch1:30 pm Improving Cancer Outcomes in Camden Introduction and
Outcomes from Upper and Lower GI auditDr Lucia Grun
1:50 pm BMJ Cancer Learning ToolDr Matt Morgan
2:00pm Bowel Scope and Colonoscopy Straight to Test Dr Ed Seward
2:30pm Consultant led case study discussions3:30 pm Refreshment Break
3:55pm Consultant led case study discussions continued
4:55 pm Feedback and Close
Camden CCG is working with London Cancer and BMJ OnExamination to
provide a GP Development Tool for all GPs to improve the earlier detection of
cancer within Camden.
What does the Assessment Package contain?
• A Pre-test (25 questions) - From the results of this Pre-test 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 8 x Self Assessment modules (10 questions each) will be provided with relevant learning material based on knowledge test results
• A Post-test (25 questions) - to confirm knowledge improvement by engaging with the Self Assessment modules
Launch: Wednesday 22nd October
Benefits to you:
• At least 10 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
ANY QUESTIONS?