Audit Shows Better Care For Head And Neck Cancer Patients, But Still Room For Improvement, England And Wales

Main Category: Ear, Nose and Throat
Also Included In: Cancer / Oncology;  Neurology / Neuroscience
Article Date: 01 Oct 2008 - 5:00 PDT

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Head and neck cancer patients in England and Wales are receiving better care than in previous years, but there is still room for improvement, the latest National Head and Neck Cancer audit shows.

93 per cent of cases were reviewed by multi-disciplinary teams (MDTs) of health professionals, considered pivotal to ensure the best standard of care, from November 1 2006 to October 31 2007.

This is 20 per cent more than the previous year, although National Institute of Clinical Excellence (NICE) guidance recommends 100 per cent of cases are reviewed by MDTs. The audit identified the need for head and neck cancer teams to provide assurance to trust boards on this important aspect of care delivery.

Focusing on voice box (larynx) and mouth (oral cavity) cancers, the audit continuously collects and updates anonymous data from each patient service contact, from the 36 cancer networks across England and Wales. This allows national assessment of outcomes and aims to help improve the quality of patient care.

Now in its third year, the audit includes a wide variety of outcomes provided in a trust identifiable format for the first time, and also includes a guide which gives each trust a score for data completeness. It highlights an improvement in the level and quality of data submission from the cancer networks, but highlights the need for further improvement.

The audit is supported by a wide group of both medical and non medical professional bodies, the British Association of Head and Neck Oncologists (BAHNO) and health departments in England and Wales. It is commissioned by the Healthcare Quality Improvement Partnership and managed by The NHS Information Centre.

The audit also shows:

-- The majority (89 per cent) of patients were older than 50+ years, and of these 71 per cent were male. (Larynx; 92 per cent of larynx cases were 50+years, of which 83% were male and oral cavity; 86 per cent were 50 yrs+, of which 57 per cent were male).

-- One in five oral cavity cancer patients are referred via the general dental practitioner/community dental service route, but of these only a quarter are via the two week wait urgent referral pathway. The audit identified the need for cancer networks to examine local pathways and their effective usage.

-- The audit identified variation in the time taken from a patient or carer first recognising suspicious symptoms to visiting a doctor or dentist, raising questions of the psychological response to the possibility of cancer.

-- Prompt diagnostic imagining of patients has improved, with 11 patients having to wait more than four weeks in 2006/7 compared to 37 patients in 2005/6.

-- Data submissions on pre treatment speech and swallowing and dietetic assessment improved, for example, but still represented a small number of cases.

Two networks did not participate in the audit and, of the other 34; there was a variance in record completeness. The audit identified the need for executive teams in NHS organisations to ensure prioritisation of head and neck cancer in their audit programmes.

Each contributory organisation is encouraged to develop a local action plan based on the audits findings.

The NHS Information Centre's chief executive Tim Straughan said: "It is pleasing to see an improvement in data submissions to the audit, but cancer networks still have food for thought in terms of improving these further. Ultimately, better submissions will lead to a more comprehensive picture of patient care and help improve such care in the future."

Professor Mike Richards, National Cancer Director, said: "This audit provides useful information on the average intervals between diagnosis and treatment for patients with laryngeal and oral cancer. This should provide a useful baseline for Trusts in England as they prepare to achieve the waiting time targets set out in the Cancer Reform Strategy."

Dr Jane Hanson, Advisor for Cancer Services to the Wales Assembly Government and Director of the Cancer Services Co-ordinating Group, said: "It is good to see that considerable progress has been made in overall case ascertainment. Our next priority is to improve on recording the stage of disease. During 2008 roll out will commence of on-screen histopathology reporting that will feed directly into our national cancer information system, CANISC. We expect this will make a significant improvement that will be reflected in future National Head and Neck Cancer Annual Reports".

Richard Wight, Consultant Head and Neck Surgeon, and head and neck audit lead, said: "Further pieces of the complex puzzle of head and neck cancer care have been revealed, and as comprehensive submissions continue to rise, a more complete picture of head and neck cancer will emerge. This report is yet another stride along this road."

-- Click here to view the report.

1. The Head and Neck Cancer Audit (DAHNO) provides a continuous electronic comparative audit on the management of head and neck cancer in England and Wales. The project is supported by a wide group of both medical and non medical professional bodies, by the British Association of Head and Neck Oncologists (BAHNO) and by health departments in England and Wales. This audit was initially commissioned and funded by the Healthcare Commission. Funding responsibility for this, and other national audits, passed to the Healthcare Quality Improvement Partnership (HQIP) from 1st April 2008.

2. This third report presents data collected on new registrations from 1 November 2006 to 31 October 2007 and treatment data up to the 19 November 2007. The Head and Neck Cancer Audit focuses on voice box (larynx) and mouth (oral cavity) cancers and provides a continuous electronic comparative audit on the management of head and neck cancer in England and Wales. The audit will allow national assessment of outcomes and provide a tool to improve the standard of care, identifying areas of good practice to teams delivering head and neck cancer care. The national head and neck cancer audit aims to improve both the volume and quality of data submissions, and from this, provide comparative feedback to NHS Provider Trusts, with the ultimate aim of improving patient care.

3. Patients with head and neck cancer require intensive investigation, multi-modality treatments and rehabilitation with long-term support to achieve an adequate recovery. In order to confirm the quality of care received by patients, anonymous data on individual patients needs to be collected and analysed. The head and neck cancer audit continuously collects data from each patient service contact and the record is continually updated.

4. In England, 67 per cent (1,882) of an estimated 2,820 cases were submitted, compared to 49 per cent in the previous year, which is a significant rise with improved data completeness particularly on staging. In Wales, 72 per cent (153) of an estimated 212 cases were submitted, compared to 83 per cent in the previous year, which is a high level but with varying data completeness.

5. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

NHS - The Information Centre
www.ic.nhs.uk