March 2002 Outcomes in thyroid cancer: what factors are important? Information Projects Team...
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![Page 1: March 2002 Outcomes in thyroid cancer: what factors are important? Information Projects Team Outcomes in thyroid cancer: what factors are important? NYCRIS.](https://reader031.fdocuments.us/reader031/viewer/2022012922/56649cce5503460f94998ec1/html5/thumbnails/1.jpg)
Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
Outcomes in thyroid cancer: what factors are important?
NYCRIS Regional Audit
Cathy Bennett
Information Projects Manager
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
UPDATE
• Fourth steering group meeting• Results of the pilot study
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
AIMS AND OBJECTIVES - 1
• To publish the anonymised results of the audit in a form which is freely accessible and to encourage participating hospital Trusts and health care professionals to use the findings to adopt best practice.
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
AIMS AND OBJECTIVES - 2• To determine whether patients diagnosed with thyroid
cancer in the Northern and Yorkshire Region in 1998 and 1999 received appropriate care, as compared with the NCN/BAES (2000) guidelines.
• To assess the specialties, workload, and extent of multi-disciplinary team working of clinicians who managed thyroid cancer patients in the Northern and Yorkshire Region in 1998 and 1999.
• To determine the outcomes of patients diagnosed with thyroid cancer in 1998 and 1999 (Northern and Yorkshire).
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
OVERVIEW
• Case note review of 51 patients diagnosed in 1998• Case notes available for 35 patients
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
PATIENTS n=35Sex Males 31% Females 69%Age Mean 57.8 Median 63
Min 27 Max 86Sdev 17.7
Network of First Hospital Northern 26%Yorkshire 63%Humber and Yorkshire Coast6%Tees 6%
Pathology Anaplastic 9%Follicular 26%Medullary 6%Papillary 57%Unspecified 3%
No. died 20% of which 3 wereanaplastic, 2 follicular, 1papillary and 1 unspecified
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
Consultant 1 Specialty
GEN S
ENT S
THO S
GEN M
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
Consultant 2 Specialty
GEN S
ENT S
R/T
null
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
Consultant 3 Specialty
R/T
ENT S
null
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
REFERRAL AND TREATMENT DATES (DAYS)
GP* to Hosp 1* Hosp 1* to Surg 1 Surg 1 to Surg 2 Surg 1 to XRT*Count 7 28 19 13Median 15 81 42 88Min 1 0 3 11Max 33 255 343 235
*registry data
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
CHALLENGE SCAN INTERVALS (DAYS)
XRT* to First Scan First to Sec Scan Sec to Third Scan Hosp 1* to LastSeen
Count 13 12 7 29Median 84 98.5 119 994Min -70 7 3 30Max 273 863 253 1372
*registry data
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
SURGERY and PATHOLOGY
• Surgery and pathology - pathology and type (categorise surgery), insufficient stage, grade and pathology data in case notes.
• Initial and completion surgery - we need to categorise these types of surgery - see new data collection form
• Very little data on size of tumour• General revision of the data collection form for the
main study
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
COMPLICATIONS
• hypoparathyroidism - how is this defined? Is there a test or treatment that would help to identify this condition?
• Post -op. and long term - some data available - please see results sheet
• Radioiodine - not recorded - may be in nursing notes?
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
LONG TERM FOLLOW-UP
• TSH level (Mu/L)
• Various values, units unclear - need an endocrinologist!
• Some data available - see data collection form - do we continue to collect this?
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
OUTCOMES
cause-specific death overall disease free survival early side effects of radioiodine treatment distant and local recurrence recurrent laryngeal nerve damage hypoparathyroidism
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
OUTCOMES - Definitions cause-specific death - death from thyroid cancer overall disease free survival - 1 yr, 3yr, revisit at 5yr
(not case notes) early side effects of radioiodine treatment - early?
nature of side effects? distant and local recurrence - distant/local? How is
recurrence defined? time point? recurrent laryngeal nerve damage - how defined?
duration? hypoparathyroidism - how measured/defined,
temp/permananent, duration? time limits?
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
PLANS FOR THE MAIN STUDY
• Changes to data collection form• Revised as a result of papers by Hundahl and Holzer
(2000)• Simplified according to data available.• Expand main study to all 1998 & 1999 patients (n~250)• Analyses - consultant speciality, type of pathology and
surgery etc. Working group.
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
QUESTIONNAIRES
• Consultants, Oncologists and MDT• Sample n=51 patients, all consultants in patient
pathway, plus names of clinicians referred by colleagues
• Administration tested• Reasonably good response rates, some data available• Patterns of care emerging
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
CONSULTANT QUESTIONNAIRE• All consultants in patients pathway (n=46)• 56% response rate• Range of general details available• Non MDT work - 67% routinely meet with clinical and
medical oncologists in the course of their work, usually after surgery
• Patient support is an area that may warrant further investigation by others
• Patterns of follow up care are emerging• Guidelines 40% BTA, 20% NCN, also local and BAES
in use
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
ONCOLOGIST QUESTIONNAIRE
• Identified from registry database, referred to by other consultants (n=17)
• 41% response rate• Specialism in thyroid (4), also, endocrine, breast, H&N,
gastro., lung, urol., skin, gynae.• Links with surgeons usually after treatment• Follow up - some differences between oncologists’
and surgeons’ responses - do we need to collect these data from oncologists as well as surgeons?
• Guidelines - none recorded guidelines
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
MDT QUESTIONNAIRE 1
• 118 questionnaires sent out, 51% response rate• 6 MDTs identified, in YCN, NCN, CCA but not H&YC
networks• Analysis compares teams A-F• Thyroid MDTs cover other endocrine, H&N, breast• Some differences in year of first formal meetings
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
MDT QUESTIONNAIRE 2 MANAGEMENT OF PATIENTS
• Differences in meeting prospectively or after surgery, how selection is made was not recorded
• All patients are discussed after surgery• Formal recording of treatment plans• Involvement of pathologists• Communication to primary care• Patient support is variable• Standard protocols for follow up• Work to guidelines
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Information Projects Team March 2002Outcomes in thyroid cancer: what factors are important?
QUESTIONNAIRES - MAIN STUDY?
• Is this useful information?• Changes to the questionnaire forms?• Expand to all consultants in main study 1998 and 1999
patients• Current practice - how to correlate to study patients.
– By network - which patients are being seen by MDTs or individuals?
– Correlation of MDT vs. individual care to outcome? • Useful analyses - Working group.