Please note that the treatment statistics for certain skin tumours, namely keratinocyte cancers (BCC and cSCC), are currently experimental and likely undercount surgical tumour resections. NDRS is working on improving the methodology to identify skin surgical treatments using additional data sources, and hopes to include the improved methodology in the next data release.
The fact of treatment with resection, chemotherapy, and radiotherapy (in the initial treatment period) is defined as a “yes/no” binary indicator for each malignant cancer registered. Three variables indicate whether any resection, chemotherapy, or radiotherapy was received. There are also 8 mutually exclusive variables that indicate the combination of resection, chemotherapy, and radiotherapy received.
The AV2019.AV_TREATMENT_TABLE_1319_4P7 dataset in CASREF01 and the end of year AV2019.AV_TUMOUR dataset is used to produce these figures. The methodology for creating AV2019.AV_TREATMENT_TABLE_1319_4P7 is detailed in the CAS-SOP #4.7_treatments1319.
The cohort was defined to align with the cohort specified in GDO_0025_tech_doc_Incidence, which in turn is generated from the methodology and standard restrictions in the CAS SOP #1 – Counting Cancer Cases. This SOP was followed, with the additional exclusions of testicular tumours in female patients and ovarian tumours in male patients for tumours whose ICD code starts with D. (The SOP handles C-coded tumours but does not yet perform any exclusions on D-coded tumours: sex-exclusions are performed on all tumours for our dataset). The cohort was created from the end of year AV2019.AV_TUMOUR dataset. Cases not meeting the SOP criteria are excluded from the cohort. Once the restrictions have been applied the cohort is refined using diagnosis year and site codes to select the relevant cohort of interest.
The original treatment flags were only defined for ICD-10 C-coded tumours, but the cohort has been widened to run for some D-coded tumours in our last release. However, the flags are not produced for all D- coded tumours covered by GDO – D-coded sarcomas and D-coded skin still have no treatment flags. Where data cannot be calculated because the group includes D-coded tumours, this is denoted by this value ‘.d’.
In some cases, full treatment data could not be calculated because surgery codes have not yet been defined by the therapeutics team. This means that while chemotherapy and radiotherapy data can be provided, both individual and combinatory treatments involving surgical resection cannot be reported on. This issue affects bone cancer, Kaposi Sarcoma, soft tissue and peripheral nerve cancer, most sarcomas, and D-coded tumours of bladder, urethra, renal pelvis and ureter and kidney. Where data cannot be calculated because the group lacks definition of the relevant surgery codes, this is denoted by this value ‘.m’.
Treatment with resection, chemotherapy, and radiotherapy was defined in the AV2019.AV_TREATMENT_TABLE_1319_4P7 dataset. The timeframe after diagnosis to include as part of a patient’s first course of treatment varies by cancer site and treatment. Resections were also defined using a list of OPCS4 codes, agreed with clinicians. These are detailed in CAS-SOP #4.7_treatments1319. The 8 mutually exclusive variables were calculated from the figures in AV_TREATMENT_TABLE_1319_4P7.
GDO aims to produce clinically meaningful groupings of cancer sites. Care should be taken when comparing these figures with earlier publications, as the definition of cancer sites may vary. For more information, see the supporting information for incidence figures for each cancer site on the Get Data Out website.
Where a group size is very small, data are not available as a measure to protect patient confidentiality. This is indicated with ‘.k’.
If resection procedure codes have not been defined for either all or part of a group, this is indicated with ‘.m’.
A full definition of these codes can be found in the GDO missing file.
“Other care” represents the group of patients who had no record of chemotherapy, tumour resection, or radiotherapy in the time frame assessed. This may include patients who received other treatments (such as hormonal therapy or management of symptoms), treatment outside of the time frame assessed, treatment in a private setting, or there may be data missing from the datasets used.
The registry data on Kaposi sarcoma could be biased, including people with a pathological diagnosis but excluding clinically diagnosed people whose care is managed in GUM-HIV clinics, who may not routinely send data to the registry. Additionally, the primary treatment for Kaposi sarcoma may by antiretroviral therapy, which is not captured by the cancer registry. The treatment data in this publication only focuses on chemotherapy, radiotherapy and surgery and as such we may be reporting that people are not receiving treatment when in fact they are receiving treatments we don’t cover.
The QA was done internally by the Get Data Out team.
Any questions, please contact sally.vernon1@nhs.net, polly.jeffrey1@nhs.net, hannah.maconochie1@nhs.net, sean.mcphail1@nhs.net