National Audit of Breast Cancer in Older Patients: Annual Reports

National Audit of Breast Cancer in Older Patients: Annual Report 2021
HQIP 12 August 2021

• Based on data from women aged 50+ years diagnosed with breast cancer between January 2019 and 31 July 2020, this report reviews diagnoses and treatment patterns across England and Wales, taking the early months of the pandemic into consideration. Outcomes among women diagnosed between January 2014 and December 2018 were also examined within the report.

National Audit of Breast Cancer in Older Patients – 2020 Annual Report
HQIP 9 July 2020

• A report of the process and outcomes of care for 185,648 patients, aged 50 years and over, diagnosed with breast cancer between 1 January 2014 and 31 December 2018 in England and Wales. Information from the English Cancer Patient Experience Survey (CPES), completed by patients diagnosed in England in 2015 to 2018 is included.

National Audit of Breast Cancer in Older Patients: 2019 Annual Report
HQIP 9 May 2019

• A report of the process and outcomes of care for 147,162 patients, diagnosed with breast cancer between 1st January 2014 and 31st December 2017 in England and Wales. This is the first report using data linked from the English Cancer Patient Experience Survey (CPES) to the NABCOP patient-level data.

Transcranial magnetic stimulation for obsessive-compulsive disorder

Transcranial magnetic stimulation for obsessive-compulsive disorder
NICE Interventional procedures guidance [IPG676] 05 August 2020

• Evidence on the safety of transcranial magnetic stimulation for obsessive-compulsive disorder raises no major safety concerns. However, evidence on its efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.

Dynamic early identification of hip replacement implants with high revision rates.

Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012.
PLoS One. 2020;15(8):e0236701. Published 2020 Aug 4. doi:10.1371/journal.pone.0236701

• The authors have developed an algorithm for early detection of poorly performing components in hip replacement surgery.

Abstract

The impact of frailty on the economic evaluation of geriatric surgery

The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis.
J Med Econ. 2020;23(8):819-830. doi:10.1080/13696998.2020.1764965

• Two systematic reviews and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients concluded that frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources.

Abstract

Third phase of NHS response to COVID-19

Third phase of NHS response to COVID-19
NHS England 31 July 2020

• Update on the latest Covid national alert level; priorities for the rest of 2020/21; and an outline of financial arrangements heading into Autumn as agreed with Government.
• A: Accelerating the return of non-Covid health services, making full use of the capacity available in the window of opportunity between now and winter
• A1. Restore full operation of all cancer services.
• A2. Recover the maximum elective activity possible between now and winter
• A3. Restore service delivery in primary care and community services.
• A4. Expand and improve mental health services and services for people with learning disability and/or autism
• B: Preparation for winter alongside possible Covid resurgence
• C: Doing the above in a way that takes account of lessons learned during the first Covid peak; locks in beneficial changes; and explicitly tackles fundamental challenges including support for our staff, action on inequalities and prevention.
• C1. Workforce
• C2. Health inequalities and prevention.
• Financial arrangements and system working 
• Financial arrangements for CCGs and trusts set out in Annex Two.

ICNARC report on COVID-19 in critical care

ICNARC reports on COVID-19 in critical care
ICNARC updated 31 July 2020

• An updated report presents analyses of the latest data on patients critically ill with confirmed COVID-19 reported to ICNARC from critical care units participating in the Case Mix Programme (the national clinical audit covering all NHS adult, general intensive care and combined intensive care/high dependency units in England, Wales and Northern Ireland, plus some additional specialist and non-NHS critical care units).

How to cost the implementation of major system change: case study using reconfigurations of specialist cancer surgery in part of London, UK

How to cost the implementation of major system change: case study using reconfigurations of specialist cancer surgery in part of London, UK [Presentation]
HSRUK 2020

• Abstract of a presentation given at HSR UK 2020 illustrating a framework and principles for costing major system change implementation. The case study uses the RESPECT-21 mixed-methods evaluation of specialist surgery services reconfiguration for prostate, bladder, renal and oesophago-gastric cancers, and focuses on a London region [UCL] where services for eight cancer pathways were centralised to fewer high-volume units.
• Presentation available here. [YouTube]

Abstract

The impact of COVID-19 on cancer patients in the UK

The impact of COVID-19 on cancer patients in the UK: Cancer Research UK Cancer Patient Experience Survey 2020
Cancer Research UK 28 July 2020

• Survey of 1,868 cancer patients (1st to 28th May) to understand the impact of COVID-19 on cancer patients’ testing, treatment and care, day-to-day lives and wellbeing, and support for government policies.

The organisation of Oral and Maxillofacial services

The organisation of Oral and Maxillofacial services: Developing integrated networks of care
GIRFT and the British Association of Oral and Maxillofacial Surgeons (BAOMS) July 2020

• The advice pack supports the implementation of recommendations in the GIRFT national report on oral and maxillofacial surgery, published in November 2018, to improve efficiency by organising care through networks. These networks offer a range of benefits such as leading to more equitable access to treatment for patients and better outcomes, as well as making more effective use of clinicians’ time and skills.

GIRFT and the Care Quality Commission (CQC) MOU

New agreement between GIRFT and the Care Quality Commission (CQC)
GIRFT 27 July 2020

• The Getting It Right First Time (GIRFT) programme and the Care Quality Commission (CQC) have published a new Memorandum of Understanding (MoU) agreement.
• The agreement sets out how the independent regulator of health and adult social care in England will work with those leading the GIRFT programme to safeguard the wellbeing of people receiving health and social care in England, promote patient safety and support improvements in care.

Understanding the link between health systems and cancer survival

Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model
Journal of Cancer Policy v25, September 2020, 100233

• Health system contribution to variation in cancer outcomes remains largely unexplained. This paper presents a conceptual model which depicts the complex interactions along the cancer care pathway. Possible ‘breakpoints’ are highlighted which may have adverse impacts on outcomes. The model provides a novel way to identify where health services could be adapted.

Senate Council Adopt, Adapt, Abandon: What have we learned about how health care can be delivered during the last twelve weeks?

Senate Council Adopt, Adapt, Abandon: What have we learned about how health care can be delivered during the last twelve weeks? East of England Clinical Senate Council July 2020

• This short paper summarises the discussion of East of England Clinical Senate Council on 24 June 2020 and presents its key findings and recommendations Members brought their own experiences and perspectives to the discussion with a view to summarising whether the changes made in the course of responding to the COVID-19 incident, could be adopted, adapted or abandoned as the health and care services look to restore services for patients.

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.
Lancet Oncol 2020, 20 July 2020; https://doi.org/10.1016/S1470-2045(20)30388-0
See Online/Comment https://doi.org/10.1016/S1470-2045(20)30391-0

• In this study the authors estimate the impact of delays in diagnosis on cancer survival outcomes in four major tumour types: breast cancer, colorectal cancer, oesophageal cancer, and lung cancer. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years.

Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK:

Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study
Lancet Oncol 2020 20 July 2020 https://doi.org/10.1016/S1470-2045(20)30392-2

• During the COVID-19 lockdown, referrals via the 2-week-wait urgent pathway for suspected cancer in England, UK, are reported to have decreased by up to 84%. This research examined the impact of different scenarios of lockdown-accumulated backlog in cancer referrals on cancer survival, and the impact on survival per referred patient due to delayed referral versus risk of death from nosocomial infection with severe acute respiratory syndrome coronavirus.

Abstract

Routes to Cancer Diagnosis data

Routes to Cancer Diagnosis 2010-2017
National Cancer Registration and Analysis Service (NCRAS) 14 July 2020

• Routes to Diagnosis categorises the pathways that lead to a patient’s diagnosis of cancer. These results provide an overview of the results for 2006 to 2017, showing the trends over time for all malignant neoplasms (excluding non-melanoma skin cancer) and a snapshot of results in 2017 for female breast, colorectal, lung and prostate cancers.
• One of the aspects highlighted by Routes to Diagnosis is the inequality in how people are diagnosed. A study by Herbert and others found that age and deprivation affect the route to diagnosis. Older people continue to make up the bulk of those diagnosed as an emergency presentation, and those who are more deprived are also more likely to be diagnosed through this route.

CFHealthHub for managing cystic fibrosis during the COVID-19 pandemic

CFHealthHub for managing cystic fibrosis during the COVID-19 pandemic
Medtech innovation briefing [MIB219] 10 July 2020

• This Innovation briefing summarises the evidence around CFHealthHub, a digital platform to help adults with cystic fibrosis (CF) manage their condition and monitor their medicine use. It allows remote access from the patients home to monitor medicines adherence.

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: theUK consensus position.

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: theUK consensus position.
Br J Cancer (2020). https://doi.org/10.1038/s41416-020-0980-x

• A consensus from UK clinicians with an interest in pancreatic cancer for management approaches that would minimise patient risk and accommodate for healthcare service restrictions.

Abstract

New approaches to cancer care in a COVID-19 world

New approaches to cancer care in a COVID-19 world
The Lancet Oncology v21(7) E339-E340, 1 July 2020. DOI:https://doi.org/10.1016/S1470-2045(20)30340-5

"Cancer is a major cause of morbidity and mortality, made acutely worse by the COVID-19 pandemic, and requires sustained investment and coordinated planning in a COVID-19 world. Health leaders now need to safeguard capacity and regain lost progress in cancer control. Available resources should be directed to those most likely to benefit. National media campaigns should be used to boost screening uptake and help-seeking behaviour for potential cancer symptoms, addressing the current delays and barriers in access to health care. Investment in cancer diagnostic workforces will be key, particularly in building up provisions for tests and biopsy procedures and shortening diagnosis-to-treatment intervals. The pandemic has also created opportunities to improve efficiencies in care, such as virtual consultations and visits. Facilitating multidisciplinary team meetings digitally is one of many potential changes requiring long-term investment in technology and infrastructure."

This article presents a series of recommendations to inform policies which deal with a new cancer burden in a post-COVID-19 environment and to mitigate a potential crisis in excess deaths due to cancer.

Recommendations:

Direct Commissioning Unintended Consequences of COVID 19 on the Quality of Our Health Service Provision

Direct Commissioning Unintended Consequences of COVID 19 on the Quality of Our Health Service Provision 

PHINE Network North East [Registration required]
NHS E/I May 2020 (uploaded 25 June 2020)

• Presentation of impact of COVID-19 on NHS England directly commissioned services.

Can Machine-learning Algorithms Predict Early Revision TKA in the Danish Knee Arthroplasty Registry?

Can Machine-learning Algorithms Predict Early Revision TKA in the Danish Knee Arthroplasty Registry?
Clin Orthop Relat Res. 2020;10.1097/CORR.0000000000001343. doi:10.1097/CORR.0000000000001343

• Although several well-known presurgical risk factors for revision were coupled with four different machine learning methods, the authors could not develop a clinically useful model capable of predicting early TKA revisions in the Danish Knee Arthroplasty Registry based on preoperative data.