Silent theatre 1 – Monday 4 November

10:30 am-11:00 am

Room: Hall 4


Programme session type(s): Silent theatre

Cancer Quality of Life Metric Project – Lessons learned from an implementation pilot
Speaker: Alice Simon
Affiliation: NHS England, London UK

Abstract:

Quality of life (QoL) outcomes are important to patients. The NHS long term plan recognises this issue. A feasibility and acceptability pilot in cancer patients is testing data collection and production of QoL metric scores to support patient, regional and national level monitoring.

Method

Five Cancer Alliances (in seven hospital trusts) are testing data collection processes. Breast, prostate and colorectal cancer patients complete two questionnaires (EQ-5D; EORTC QLQ-C30). Patients are invited to the survey using an electronic platform. Non-responders are reminded with an option to use a paper questionnaire. A subset of patients is asked to repeat the survey 6-months later. Responses are linked to demographic, disease and treatment data held by the National Cancer Registration and Analysis Service. Analyses are testing appropriateness of different summary or sub-scores for benchmarking QoL outcomes. A small-scale test providing individual-level feedback to patients and clinicians is included. A process evaluation includes qualitative interviews and focus groups with administrators, patients and clinicians, plus quantitative monitoring of coverage and uptake.

Results

To date, N=3441 patients have been invited to participate with N=1758 (51%) completing questionnaires. N=1003 (57%) completed electronically and N=755 (43%) by paper. Qualitative evaluations highlighted challenges in identifying, inviting and reporting on cancer patients. Patients supported the use of the two questionnaires for metric monitoring, but also recommended inclusion of cancer-specific questionnaires. Patients prefer a traffic-light visual summary of their data rather than figures alone.

Conclusion

Both electronic and paper options for completion are necessary. Data collection systems must have as little impact on the delivery of care as possible. Summary data should integrate into care pathways to facilitate support that underpins improvements in patient outcomes. Through the collection of national data and appropriate case-mix adjustments, it will be possible to give clear expectations of outcomes for patients with different tumour sites and clinical characteristics.

Cancer Together with other Chronic Health conditions: understanding population characteristics and healthcare resource use in general practice (CATCH)
Speaker: Michelle Collinson
Affiliation: Clinical Trials Research Unit, University of Leeds, Leeds, UK

Abstract:

Many people living with cancer have other comorbidities e.g. diabetes or depression, leading to treatment and care complexities. Cancer care is routinely provided in secondary care, however comorbidities are managed in primary care. No studies have examined the prevalence of comorbidities using the Quality and Outcome Framework (QOF) or the healthcare useage of people living with cancer and comorbidities in England.

Method

CATCH, funded by Macmillan Cancer Support, is a cross-sectional observational study aiming to describe the population size, characteristics and healthcare useage of people living with cancer and comorbidities.

Data were obtained from ResearchOne, a database of electronic patient records from English GP practices. Patients ≥50 with a cancer diagnosis consistent with QOF eligibility during 2005-2016 were included. Data included patient socio-demographics, presence of comorbidities and healthcare useage from 391 general practices (5.1% of English practices).

Results

Analysis is ongoing. We identified 99,188 people living with cancer; 56% had at least one comorbidity diagnosed in the two years prior to cancer. Hypertension was recorded as the most common comorbidity (22% of patients). More men were living with cancer and a comorbidity than women (54% vs. 46%).

60% of patients living with cancer and without comorbidity attended a primary care appointment in the 12-month period after cancer was recorded in the GP record; this was no different for those with a comorbidity. The average number of appointments attended per month was similar for those with and without comorbidity (1.5 vs. 1.2) however the average number of appointments attended per month increased with the number of comorbidities (up to 2.2 for those with >5 comorbidities).

Conclusion

CATCH provides the first estimates of the population size, clinical and healthcare useage characteristics of people living with cancer and QOF eligible comorbidities in England. It highlights the needs of this group and areas for future research.

Phenotype dictates outcome in synchronously resected primary colorectal tumours and matched liver metastases
Speaker: Kathryn Pennel
Affiliation: University of Glasgow, Glasgow, UK

Abstract:

5-year survival of patients with resectable colorectal liver metastases is 25-40%.  These patients do not generally benefit from immunotherapy although the majority are MMR proficient.  The view that high inflammatory infiltrate confers better prognosis, is overly simplified and it is likely the balance of the immune cells influences outcomes. As neutrophils are associated with poor prognosis and many express chemokine receptor CXCR2, we hypothesised that CXCR2-positive neutrophils drive stromally dense phenotypes resulting in poor outcome in some patients.

The current study examines, in-depth the relationships between, phenotype, cellular infiltrate, tumour cell signalling, clinicopathological features and outcomes in primary and secondary colorectal cancer.

Method

A unique cohort of synchronously resected primary colorectal tumours and matched liver metastases (n=46) were stained for markers of immune cell infiltration (CD4, CD8, CD68, MPO) and inflammatory signalling pathways (CXCL2, MMP9, HIF-1α, CRP) using immunohistochemistry. Tumours were phenotypically subtyped using Klintrup-Mäkinen grade (KM), tumour stroma percentage and Ki67 proliferation-index.

Results

Patients with immune phenotype (high KM grade) in both primary and secondary sites had the best prognosis and those with high intra-tumour-stroma exhibited worst prognosis (p=0.006). Presence of high levels of macrophages (CD68) associated with CXCR2 positive cells (p=0.018) and when these were both present in high numbers in both sites associated with stromal phenotype (p=0.021), tumour budding (p=0.002) and worse prognosis (p=0.002). Intra-tumour neutrophils (MPO) associated with CXCR2 expression(p=0.042). Macrophages, MMP9, and C-Reactive Protein expression increased between primary tumours and matched liver metastases, whereas lymphocyte infiltration (CD4, CD8), HIF-1α and CXCR2 expression was not observed to change.  

Conclusion

We observed an increase in cancer-specific survival in patients with high immune cell infiltrate when compared with patients with high levels of intra-tumour stroma.  Patients whose tumours exhibited this stromal phenotype had poor prognosis and were more likely to have infiltration of myeloid-cells including CXCR2-positive cells.

Understanding international variation in access to PET-CT for oncology diagnostics: An International Cancer Benchmarking Partnership (ICBP) study.
Speaker: Charlotte Lynch
Affiliation: Cancer Research UK, London, UK

Abstract:

PET-CT is an important diagnostic tool within cancer care, with evidence supporting its specificity, accuracy and sensitivity in detecting tumours, metastatic spread, and treatment monitoring. Variation in access to diagnostics has been identified as a potential contributor to international cancer survival differences. This study is the first to our knowledge exploring the differences between PET-CT guidelines, capacity and issues surrounding effective service delivery.

Method

Mixed methods including quantitative data collection on 4 access metrics (capacity, use, cost, location) from existing administrative data in 17 jurisdictions across high-income countries (UK, Ireland, Norway, Denmark, Canada, Australia, New Zealand) from the year 2000 onwards. Capacity was measured by scanner quantity and waiting times; use was measured by the number of scans carried out annually in the general and cancer populations. Literature searches were performed for clinical indication evidence. Descriptive comparative analyses were produced of use, capacity and indication guidance for PET-CT services between jurisdictions.

Results

11/17 jurisdictions were able to provide complete data on scanner location and capacity.  Number of PET-CT scanners ranged from 0.05 to 0.66 per 100,000. Acquisition of scanners over time showed the greatest increase in Denmark, 0.02 scanners per 100,000 in 2007, to 0.66 in 2017. Indications ranged between jurisdictions, with potentially clinically important differences seen in recommendations for colorectal cancer staging and within recommendations for non-small cell lung vs small-cell lung cancers. Data access, sources and definitions surrounding PET-CT services varied significantly across ICBP jurisdictions.

Conclusion

The lack of international PET-CT data availability and service consistency may act as a barrier in monitoring and implementing effective PET-CT services internationally. There is an unmet need in capturing more consistent, richer data relating for PET-CT activity to facilitate sharing of best practice and improve future planning for healthcare provision. Availability of PET-CT should be considered as a proxy for investment in, and quality of cancer care.