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?

Click icon to add picture

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, carol.murphy@cancer.org.uk

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?