Faster cancer treatment indicators: Data definitions and reporting for the indicators

Transcription

1 Faster cancer treatment indicators: definitions and reporting for the indicators March 2012

2 Contents Purpose... 3 Faster cancer treatment indicators... 4 Rationale... 4 Reporting against the indicators... 5 Retrospective reporting... 5 collection responsibility... 5 reporting process... 6 Inclusions and exclusions for the indicators... 7 Inclusions... 7 Exclusions... 7 Reportable data items for the indicators... 8 Mandatory data items... 8 Non-mandatory data items... 8 Appendix A: Indicators in practice use cases Appendix B: Definitions of the mandatory data items Appendix C: Definitions of the non-mandatory data items Appendix D: Primary site ICD grouped into tumour streams Faster cancer treatment indicators data definitions and reporting for the indicators 2

3 Purpose This document introduces the faster cancer treatment indicators (the FCT indicators) which are included as a development measure in the 2012/13 District Health Board (DHB) Planning Package. DHBs are expected to begin collecting baseline data on the FCT indicators during 2012/13. This document identifies the data definitions for the FCT indicators and covers the necessary definitions for reporting baseline data on the FCT indicators. This sits alongside the Ministry of Health s (the Ministry) faster cancer treatment initiatives supporting quality care, including the development of tumour standards and pathways. The definitions for the FCT indicators are based on: National Cancer Core Definitions Interim Standard HISO (2011) National Health Service (Scotland) New Cancer Waiting Times Targets and Definitions Manual (2010) National Health Service (Wales) Definitions to support the Cancer Waiting Times Service and Financial Framework (SaFF) Target (2004). Faster cancer treatment indicators data definitions and reporting for the indicators 3

4 Faster cancer treatment indicators There are three indicators collectively referred to as the FCT indicators. These will be used to measure the timeliness of cancer treatment. The FCT indicators are: Indicator one: length of time taken for a patient referred urgently 1 with a high-suspicion 2 of cancer to receive their first cancer treatment (or other management) Indicator two: length of time taken for a patient referred urgently with a high-suspicion of cancer to have their first specialist assessment Indicator three: length of time taken for a patient with a confirmed diagnosis 3 of cancer to receive their first cancer treatment (such as surgery) or other management (such as palliative care) from decision-totreat 4. Rationale The FCT indicators focus on the length of time from a high-suspicion of cancer to when the patient receives their first treatment. The FCT indicators cover the breadth of the clinical cancer care pathway, including surgical treatment. Two of the FCT indicators measure from when a patient is referred with a high-suspicion of cancer (see Figure 1 on page 5). 1 Referred urgently: an urgent referral to a specialist because a person presents with clinical features indicating high-suspicion of cancer. 2 High-suspicion: means the person presents with clinical features typical of cancer, or has less typical signs and symptoms but the clinician suspects that there is a high probability of cancer. 3 The preferred basis of a confirmed cancer diagnosis is pathological, noting that for a small number of patients cancer diagnosis will be based on diagnostic imaging findings. 4 See Appendix B: Definitions of the mandatory data items, page 22. Faster cancer treatment indicators data definitions and reporting for the indicators 4

5 Reporting against the FCT indicators Reporting against the FCT indicators will be based on four data s. Figure 1 shows the data s that make up the start and stop s of the FCT indicators. Figure 1: s for the three FCT indicators Indicator two (best practice 14 days) Indicator three (best practice 31 days) Urgent referral with high-suspicion of cancer First specialist assessment Decision-to-treat First cancer treatment Indicator one (best practice 62 days) The FCT indicators are identified as a development measure in the 2012/13 DHB Planning Package, with data reporting expected from 1 July DHBs are expected to begin collecting baseline data on the FCT indicators during 2012/13. Retrospective reporting The reporting against the FCT indicators will be retrospective 5. This is because the initial focus is on routinely collecting baseline data on the three FCT indicators across the tumour types. During 2012/13 the FCT indicators are reported retrospectively only for the cohort of patients who at the time of decision-to-treat have a confirmed diagnosis of cancer. For more information on what this means in practice see Appendix A: Indicators in practice use cases. The nature of the reporting against the FCT indicators will change. The Ministry will work with the sector to develop tools that support consistent assessment of urgent referral for high-suspicion of cancer. Following this, the reporting on the length of time taken will move to real-time monitoring of each patient progressing through the pathway. Any changes to the nature of the retrospective reporting will be on an annual basis. DHBs will be notified at least three months prior to any change taking effect. collection responsibility The DHB of domicile is responsible for the collection and collation of information on the data items and submitting this information via the reporting template to the Ministry, see reporting process on page six. 5 Retrospective means that calculating the length of time it takes for each patient against the FCT indicators happens once the patient has started their first treatment. Faster cancer treatment indicators data definitions and reporting for the indicators 5

6 The DHB of domicile is responsible for collecting and reporting information on their domiciled population even if it is not the DHB of: receipt of referral service. reporting process is reported retrospectively, by the DHB of domicile, for all patients who had a confirmed diagnosis of cancer at decision-to-treat. The required data items must be reported via the reporting template in the specified format. The reporting template is accessible on the nationwide service framework library The reporting template must be submitted to the Ministry via to cancerteam@moh.govt.nz by the 20 th of the month following the reporting month. The initial focus is on the collection of baseline information and adjustments may be made to the reporting template, or reporting frequency if required. Faster cancer treatment indicators data definitions and reporting for the indicators 6

7 Inclusions and exclusions for the FCT indicators The following inclusions and exclusions are detailed for the FCT indicators. For information on how these inclusions and exclusions work in practice see Appendix A: Indicators in practice use cases. Inclusions The FCT indicators apply to all patients who: are eligible for treatment in New Zealand are either an inpatient or an outpatient are under the care of adult services have a confirmed diagnosis 6 of cancer 7 at decision-to-treat. Indicator three 8 also applies to, patients whose: cancer has relapsed pre decision-to-treat pathway is outside the New Zealand public health system and the patient is then referred to the public health system for treatment. Exclusions Patients are excluded from the FCT indicators if the patient: has a post decision-to-treat pathway that begins outside the New Zealand public health system has cancer diagnosed as an incidental finding at the time of treatment was referred urgently for a first specialist assessment for high-suspicion of cancer, which resulted in no confirmed diagnosis of cancer has low risk non melanoma skin cancer has non-invasive or non-malignant (benign) tumours has low-grade, asymptomatic or indolent haematological malignancies is referred and accepted by child cancer services. 6 The preferred basis of a confirmed diagnosis is pathological, noting that for a small number of patients diagnosis will be based on diagnostic imaging findings. 7 The cancer diagnosis is either a newly diagnosed primary cancer or a recurrent cancer. 8 The length of time taken for a patient with a confirmed diagnosis of cancer to receive their first cancer treatment (such as surgery) or other management (such as palliative care) from decision-to-treat. Faster cancer treatment indicators data definitions and reporting for the indicators 7

8 Reportable data items for the FCT indicators Mandatory data items The mandatory data items to be reported to the Ministry for the three FCT indicators are identified in the following table, see also Appendix B: Definitions of the mandatory data items. Field Indicator/s Ethnicity 9 All DHB of domicile All Date of receipt of referral 1, 2 DHB of receipt of referral 1, 2 Date of first specialist assessment 2 Primary site International Classification of Diseases (ICD) grouped into All tumour stream category 10 Date of decision-to-treat 1, 3 Type of first treatment 1, 3 Date of first treatment 1, 3 DHB of service for first treatment 1, 3 Non-mandatory data items The following table identifies the data items that the Ministry will expect DHBs to collect data on in the future. Where possible, DHBs are expected to work towards collecting these data items following routine collection of the mandatory data items, see also Appendix C: Definitions of the non-mandatory data items. Field Indicator/s National Health Index (NHI) All Age All Episode (of care) identification (ID) All Source of referral 11 1, 2 Urgency of referral 1, 2 Date patient informed of diagnosis 1, 2 Date of most valid diagnosis 1, 3 Date of multidisciplinary meeting (MDM) 1, 3 9 Ethnicity data should be recorded as per standard ethnicity data protocols. This information is accessible from 10 See Appendix D: Primary site ICD grouped into tumour streams. 11 Includes acute and elective sources of referral. Faster cancer treatment indicators data definitions and reporting for the indicators 8

9 Clock start and stop times for the FCT indicators The table below identifies when the clock starts and stops for the FCT indicators. FCT Indicators Clock start Clock stop Indicator one Urgent referral with high-suspicion of cancer to first cancer treatment. Indicator two Length of time taken for a patient referred urgently with a highsuspicion of cancer to have their first specialist assessment. Indicator three Length of time taken for a patient with a confirmed diagnosis of cancer to receive their first cancer treatment (such as surgery) or other management (such as palliative care) from decision-to-treat. The date of receipt of referral for the first specialist assessment led to the patient being diagnosed with cancer. The date of receipt of referral for the first specialist assessment led to the patient being diagnosed with cancer. The date that decision-to-treat was initiated. The date that the patient had their first treatment (or other management). 12 The date that the patient had the first specialist assessment that led to the patient being diagnosed with cancer. The date that the patient had their first treatment (or other management). 12 First treatment (or other management) is defined in Appendix B. Faster cancer treatment indicators data definitions and reporting for the indicators 9

10 Appendix A: FCT indicators in practice use cases The following use cases provide examples of how the FCT indicators work in practice. All the use case diagrams show patients who have been referred from primary care. Patients who have been referred from an emergency department or other secondary service for a first specialist assessment with high- suspicion of cancer are also included in the FCT indicators. Use case one surgery is the first treatment The following use case is an example of a patient who has surgery as first treatment. The use case demonstrates how surgery is captured in the FCT indicators. A patient is referred urgently with suspected cancer. The patient is seen by a surgeon at a first specialist assessment. Ideally the patient s clinical details are reviewed at an appropriate multidisciplinary meeting (MDM) for a management recommendation. The management recommendation is that the patient be offered surgery as first treatment. The clinician sees the patient in a follow-up assessment, and decides with the patient that the first treatment is surgery. The patient will be reported on in the FCT indicators. The FCT indicator data s are indicated by the.

11 Use case one surgery is first treatment excluded included Primary care Diagnostics Presents to general practitioner with symptoms * Diagnostics indicate suspected cancer Further diagnostics and staging Patient has a confirmed diagnosis of cancer Referral First specialist assessment Receipt of referral First specialist surgical assessment Discussed at multidisciplinary meeting * Subsequent surgical apment 14 days Decision-totreat Decision-to-treat confirmed with booking request for surgery Treatment 62 days 31 days Surgical excision of cancer * This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities. * This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting.

12 Use case two radiation treatment is the first treatment The following use case is an example of a patient with rectal cancer who has radiation treatment with concurrent chemotherapy as their first treatment. The use case demonstrates how radiation treatment is captured in both the FCT indicators and links to the Shorter waits for cancer treatment health target. Ideally the patient s clinical details are reviewed at an appropriate MDM for a management recommendation. The management recommendation is pre-operative radiotherapy with concurrent chemotherapy, followed by surgery. The data on radiation treatment and chemotherapy (decision-to-treat and treatment commencing) for the patient will be reported twice. The patient will be included in the three FCT indicators and in the Shorter waits for cancer treatment health target. The expected maximum timeframe from decision-to-treat to first treatment for patients who have radiation treatment or chemotherapy 13 as their first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer treatment health target sets a maximum timeframe of four weeks from decision-to-treat to starting radiation treatment or chemotherapy. The FCT indicator data s are indicated by the. The Shorter waits for cancer treatment health target data s are indicated by the. The links with the draft colonoscopy wait time indicator are identified by the. 13 The Shorter waits for cancer treatment health target includes outpatient chemotherapy from 1 July 2012.

13 Use case two radiation treatment is first treatment excluded included Primary care Diagnostics Presents to general practitioner with symptoms * Diagnostics indicate suspected cancer Accepted for colonoscopy Colonoscopy Further diagnostics and staging Patient has a confirmed diagnosis of cancer Referral First specialist assessment Receipt of referral First specialist surgical assessment Discussed at multidisciplinary meeting * Subsequent surgical apment First specialist radiation oncology assessment First specialist medical oncology assessment Decision-totreat 14 days Decision-to-treat confirmed with booking request for radiation treatment Treatment 62 days 28 days * Radiation treatment commenced with concurrent chemotherapy * This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities. * This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting. * Where first treatment is radiation treatment or chemotherapy the timeframe from decision-to-treat to first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer treatment health target sets a maximum timeframe of 4 weeks from decision-to-treat to starting radiation treatment and chemotherapy.

14 Use case three chemotherapy is the first treatment The following use case is an example of a patient who has chemotherapy as their first treatment. The use case demonstrates how chemotherapy is captured in the FCT indicators and links to the Shorter waits for cancer treatment health target. A patient is referred urgently with suspected cancer. The patient is seen at a first specialist assessment. Ideally the patient s clinical details are reviewed at an appropriate MDM for a management recommendation. The management recommendation is chemotherapy as first treatment. The patient will be reported on in both the FCT indicators and the Shorter waits for cancer treatment health target. The expected maximum timeframe from decision-to-treat to first treatment for patients who have radiation treatment or chemotherapy (outpatients only) as their first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer treatment health target sets a maximum timeframe of four weeks from decision-to-treat to starting radiation treatment and chemotherapy. The FCT indicator data s are indicated by the and the Shorter waits for cancer treatment health target data s are indicated by the.

15 Use case three chemotherapy is first treatment excluded included Primary care Diagnostics Presents to general practitioner with symptoms * Diagnostics indicate suspected cancer Further diagnostics and staging Patient has a confirmed diagnosis of cancer Referral First specialist assessment Receipt of referral First specialist assessment 14 days Discussed at multidisciplinary meeting * Subsequent apment Decision-totreat Decision-to-treat confirmed with booking request for chemotherapy Treatment 62 days 28 days * Chemotherapy started * This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities. * This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting. * Where first treatment is radiation treatment or chemotherapy the timeframe from decision-to-treat to first treatment is 4 weeks (28 days) not 31 days. This is because the Shorter waits for cancer treatment health target sets a maximum timeframe of 4 weeks from decision-to-treat to starting radiation treatment and chemotherapy.

16 Use case four care accessed across multiple DHBs The following use case is an example of a patient who has their first specialist assessment at their DHB of domicile, and their treatment at a different DHB. The patient was referred urgently with suspected cancer. The patient was able to be seen by a visiting clinician at a first specialist assessment in their local hospital (DHB of domicile). The clinician had diagnostic information available indicating that the patient has cancer and was therefore able to diagnose the patient with cancer. The clinician submitted the booking request for urgent surgical treatment at a different DHB. The patient had their surgery at a different hospital in a different DHB. The patient will be reported on in the FCT indicators. It is the responsibility of the DHB of domicile to report information on the patient as part of the FCT indicators. The FCT indicator data s are indicated by the.

17 Use case four care accessed across multiple DHBs excluded included Primary care Diagnostics Presents to general practitioner with symptoms * Diagnostics indicate suspected cancer Further diagnostics and staging Patient has a confirmed diagnosis of cancer Referral First specialist assessment Receipt of referral Patient attends first specialist surgical assessment at their own DHB hospital * Ideally an MDM discussion Patient attends subsequent surgical apment at another DHB hospital 14 days Decision-totreat Treatment 62 days 31 days Decision-to-treat confirmed with booking request for surgery Surgical excision for cancer DHB of domicile is responsible for collecting information from the DHB of service * This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities.

18 * This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting. Faster cancer treatment indicators data definitions and reporting for the indicators 18

19 Use case five first treatment is palliative care The following use case is an example of a patient whose first treatment is palliative care. The patient was referred urgently with suspected cancer. The patient was seen at a first specialist assessment, and the clinician had diagnostic information available indicating that the patient has cancer. The clinician was able to diagnose the patient with cancer. Ideally the patient s clinical details are reviewed at an appropriate multidisciplinary meeting for a management recommendation. The management recommendation is palliative care as first treatment. The clinician and patient discussed the treatment options, and agreed that palliative care was the best approach. In this use case example the clinician discharged the patient to their primary health care professional for palliative care. This is included in the FCT indicators. Pathways for palliative care are variable and can include referral to hospital palliative care teams or to community hospice services. If the patient subsequently has additional symptoms requiring further treatment, for example the patient s primary health care professional referred the patient for palliative radiation treatment, this would be included in the Shorter waits for cancer treatment health target. Equally the patient may be subsequently referred for surgery although this is not a measure at the present time (as this would not be the first treatment). The FCT indicator data s are indicated by the.

20 Use case five first treatment is palliative care excluded included Primary care Diagnostics Presents to general practitioner with symptoms * Diagnostics indicate suspected cancer Further diagnostics and staging Patient has a confirmed diagnosis of cancer Referral First specialist assessment Receipt of referral First specialist assessment Discussed at multidisciplinary meeting * Subsequent apment 14 days Decision-totreat Decision-to-treat confirmed with patient discharged back to primary care for palliative care * Treatment 62 days 31 days Date of decision-to-treat is date of treatment for palliative care in this example * This example has a patient who presents to their general practitioner. Patients may also present to emergency departments or other specialities. * This example notes that ideally the patient is reviewed at an appropriate multidisciplinary meeting. * This example provides one of the options for palliative care, that is that a patient is discharged to their general practitioner. There are multiple pathways to palliative care treatment including hospital palliative care assessment and referral to hospice palliative care.

21 Use case six non-malignant or low grade tumours Patients diagnosed with non-malignant or low grade tumours, for example ductal carcinoma in situ (DCIS) of the breast or chronic leukaemia, are excluded from the FCT indicators. Use case seven referred urgently, not diagnosed with cancer This example describes a patient who is referred urgently with a high-suspicion of cancer and subsequently not diagnosed with cancer. A patient is referred urgently with suspected cancer. The patient is seen by a clinician at a first specialist assessment. The clinician refers the patient for additional diagnostic tests. The diagnostic tests do not confirm the suspected cancer. As the FCT indicators are retrospectively reported on for patients who at decision-totreat have a confirmed diagnosis of cancer, this patient is excluded for all of the FCT indicators. Use case eight cancer diagnosed at surgery This example describes a patient whose cancer is diagnosed when they have their surgery. Where diagnosis is confirmed at the time of first treatment, the patient does not have a cancer diagnosis at the of decision-to-treat. They are therefore excluded from the FCT indicators. The patient and their clinician discussed the treatment options following surgery including adjuvant radiation treatment or chemotherapy and agreed that radiation treatment was the best approach. The patient is therefore included in the Shorter waits for cancer treatment health target. Use case nine first treatment private, followed by public adjuvant 14 treatment This example describes a patient who is seen by a clinician at a first specialist assessment in a private clinic. The patient is diagnosed with cancer and has their first treatment (surgery) for cancer in a private facility. Following surgery, the patient is referred for public adjuvant radiation treatment. This scenario could equally be that the patient is referred for public adjuvant chemotherapy. As the patient has their first treatment in private they are excluded from the FCT indicators. However, the patient s public adjuvant treatment is included in the Shorter waits for cancer treatment health target. 14 Adjuvant treatment is treatment that is given in addition to the primary, main or initial treatment.

22 Appendix B: Definitions of the mandatory data items Receipt of referral definition Definition: The receipt of referral date is the date the initial referral from primary care including dental is received into secondary care. Source standards: Electronic referrals Best practice is for referrals to be submitted electronically. Where referrals are submitted electronically the date of receipt of referral is the submission date on the electronic referral. Letter or faxed referrals When referrals are made by letter or fax the date of receipt of referral is the date with which the referral is stamped as having first being received in secondary care. Telephone referrals When referrals are made by telephone the date of receipt of referral is the date stamped on the formal referral (following the telephone conversation) when it has been received in secondary care. National Cancer Core Definitions Interim Standard HISO October (2011). type: Date Representational class: Full date Field size: 8 Representational layout: CCYYMMDD Obligation: domain: Guide for use: Mandatory Valid date On occasion, there will be multiple referrals for an individual patient. Where a patient has been accepted into another care pathway a clinical decision will need to be made as to whether the newer referral overrides the current pathway or not. The clinical decision needs to be documented and will determine the date of receipt of referral. Electronic referrals must consider the Referrals, Status and Discharge Referrals (RSD) suite of standards. These provide guidance for electronic information exchange when all or part of patient care is transferred from one health care provider to another as based on HL7 V2.4. Verification rules: >= Patient: Date of Birth <= Patient: Date of Death

23 Decision-to-treat definition Definition: The decision-to-treat is the date when the decision was made for the patient s treatment plan or other management plan, following discussion between the patient and the clinician responsible for treatment. Source standards: National Health Service Scotland New Cancer Waiting Times Targets and Definitions Manual (2010). type: Date Representational class: Full date Field size: 8 Representational layout: CCYYMMDD Obligation: domain: Guide for use: Mandatory Valid date Where there are two possible dates, the earliest date applies. When a patient has been discussed in a MDM, it is in the best interests of the patient that the decision-to-treat discussion with the patient takes place as soon as possible after the MDM. Where decision-to-treat is not routinely collected, the date that a booking request for treatment is made can be used as a surrogate for decision-totreat. Verification rules: N/A Faster cancer treatment indicators data definitions and reporting for the indicators 23

24 Type of first treatment definition Definition: The type of first treatment is defined as the treatment or other management that attempts to begin the patient s first treatment, including palliative care. Source standards: National Cancer Core Definitions Interim Standard HISO October (2011). National Health Service Scotland New Cancer Waiting Times Targets and Definitions Manual (2010). type: Numeric Representational class: Code Field size: 2 Representational layout: NN Obligation: Mandatory domain: Value Meaning 00 Other, please specify 01 Surgery: exclude diagnostic procedures such as punch, incisional, needle or core 02 Radiation therapy 03 Chemotherapy 04 Targeted therapy: refers to a medication / drug that targets a specific pathway in the growth and development of a tumour 05 Non-intervention management: an expectant approach pending change in the patient s circumstances. It is a period of active management not unmanaged nontreatment 06 Palliative care: an active decision for palliative care 07 Patient refused treatment 08 Patient died before treatment 99 Not recorded Guide for use: Patients should be included if first treatment is attempted but not carried out or completed for clinical reasons. For example open and shut surgery would be coded under 01 surgery. Patient s diagnostic biopsy should only be included as first treatment when the whole tumour has been removed and the margins are clear. Where first treatment is a clinical trial, the date of first treatment is considered to be enrolment in a clinical trial. Where first treatment is targeted therapy hormone therapy, the date of first treatment is considered to be the date the prescription is written for the treatment. Verification rules: N/A Faster cancer treatment indicators data definitions and reporting for the indicators 24

25 Delay code definition Definition: When the time taken for a patient to track through the patient pathway is outside the time identified for the indicator the overall time taken and the main reason for the delay must be reported. Source standards: National Health Service Scotland New Cancer Waiting Times Targets and Definitions Manual (2010). National Health Service Wales Definitions to support the Cancer Waiting Times SaFF Target (2004). type: Numeric Representational class: Code Field size: 2 Representational layout: NN Obligation: Conditional domain: Value Meaning 00 Other, please specify 01 Capacity constraint resulting from lack of resources (theatre, equipment or facilities) or process constraint including administrative errors 02 Routine staging or further investigation 03 Clinical consideration (co-morbidities) 04 Initially not suspicious of cancer 05 Patient choice to delay 06 Inadequate information available at FSA, unable to initiate decision-to-treat discussion (system / process issues) 07 Unable to initiate decision-to-treat discussion patient circumstances changed 08 Patient did not attend scheduled apment 09 Patient died before treatment 98 Not applicable 99 Not recorded Guide for use: The main reason for delay is any capacity or process delay. If no capacity or process delay occurred, the main reason for delay is the reason that contributed the longest delay. Or if there are two delays of equal length, the first delay that occurred. Verification rules: N/A Faster cancer treatment indicators data definitions and reporting for the indicators 25

26 Appendix C: Definitions of the non-mandatory data items Episode ID definition Definition: Source standards: Unique identifier for this record. National Cancer Core Definitions Interim Standard HISO October (2011). type: Numeric Representational class: Number Field size: 11 Representational layout: N(11) Obligation: domain: Guide for use: Verification rules: Mandatory Number System generated primary key for this record. N/A Faster cancer treatment indicators data definitions and reporting for the indicators 26

27 Source of referral definition Definition: The source of the referral is defined by the facility / health professional that made the referral. Source standards: National Health Service Scotland New Cancer Waiting Times Targets and Definitions Manual (2010). type: Numeric Representational class: Code Field size: 2 Representational layout: NN Obligation: Mandatory domain: Value Meaning 00 Other, please specify 01 Primary care clinician / practice 02 Primary dental clinician / practice 03 Accident and medical / after-hours 04 Emergency department 05 Other hospital department 06 Other hospital 07 Private specialist / hospital 08 National screening programme 09 Unknown Guide for use: N/A Verification rules: N/A Faster cancer treatment indicators data definitions and reporting for the indicators 27

28 Date of most valid diagnosis definition Definition: Source standards: The date on which the patient was definitively diagnosed with a particular condition or disease. National Cancer Core Definitions Interim Standard HISO October (2011). type: Date Representational class: Full date Field size: 8 Representational layout: CCYY[MM[DD]] Obligation: domain: Guide for use: Conditional Valid date The date of diagnosis is the date of the pathology report, if any, that first confirmed the diagnosis of cancer. This date may be found attached to a letter of referral or a patient's medical record from another institution or hospital. If this date is unavailable, or if no pathological test was done, then the date may be determined from one of the sources listed in the following sequence: 1. Date of the consultation at, or admission to, the hospital, clinic or institution when the cancer was first diagnosed. Note: do not use the admission date of the current admission if the patient had a prior diagnosis of this cancer. 2. Date of first diagnosis as stated by a recognised medical practitioner or dentist. Note: This date may be found attached to a letter of referral or a patient's medical record from an institution or hospital. 3. Date the patient states they were first diagnosed with cancer. Note: This may be the only date available in a few cases (for example, patient was first diagnosed in a foreign country). The CCYY component of the date is mandatory. MM is conditional (use if known). DD is conditional (use if known and MM has been recorded). If a patient is admitted for another condition (for example a broken leg or pregnancy), and a cancer is diagnosed incidentally then the date of diagnosis is the date the cancer was diagnostically determined, not the admission date. Verification rules: >= Patient: Date of Birth <= Patient: Date of Death Faster cancer treatment indicators data definitions and reporting for the indicators 28

29 First MDM meeting date definition Definition: Source standards: Date on which the patient was first discussed at a MDM. National Cancer Core Definitions Interim Standard HISO October (2011). type: Date Representational class: Full date Field size: 8 Representational layout: CCYY[MM[DD]] Obligation: domain: Guide for use: Verification rules: Conditional Valid date The CCYY component of the date is mandatory. MM is conditional (use if known). DD is conditional (use if known and MM has been recorded). N/A Faster cancer treatment indicators data definitions and reporting for the indicators 29

30 Appendix D: Primary site ICD grouped into tumour streams The ICD codes (10 th Edition) should be recorded to the third digit for all cancers. The ICD codes can be reported based on the following grouped tumour streams. ICD codes Description Grouped tumour streams to third digit C00 Malignant neoplasm of lip Head and neck C01 Malignant neoplasm of base of tongue Head and neck C02 Malignant neoplasm of other and unspecified Head and neck parts of tongue C03 Malignant neoplasm of gum Head and neck C04 Malignant neoplasm floor of mouth Head and neck C05 Malignant neoplasm of palate Head and neck C06 Malignant neoplasm other and unspecified Head and neck parts of the mouth C07 Malignant neoplasms of parotid gland Head and neck C08 Malignant neoplasm other and unspecific part Head and neck of salivary gland C09 Malignant neoplasm of tonsil Head and neck C10 Malignant neoplasm of oropharynx Head and neck C11 Malignant neoplasm of nasopharynx Head and neck C12 Malignant neoplasm of pyriform sinus Head and neck C13 Malignant neoplasm of hypopharynx Head and neck C14 Malignant neoplasm of other and ill-defined Head and neck sites in the lip, oral cavity and pharynx C30 Malignant neoplasm of nasal cavity and middle Head and neck ear C31 Malignant neoplasm of accessory sinuses Head and neck C32 Malignant neoplasm of larynx Head and neck C73 Malignant neoplasm of thyroid gland Head and neck C77 Secondary and unspecified malignant Head and neck neoplasms of lymph nodes of head, face and neck C15 Malignant neoplasm of oesophagus Upper gastrointestinal C16 Malignant neoplasm of stomach Upper gastrointestinal C22 Malignant neoplasm of liver and intrahepatic Upper gastrointestinal bile ducts C23 Malignant neoplasm of gallbladder Upper gastrointestinal C24 Malignant neoplasm of other and unspecific Upper gastrointestinal parts of biliary tract C25 Malignant neoplasm of pancreas Upper gastrointestinal C17 Malignant neoplasm of small intestine Lower gastrointestinal C18 Malignant neoplasm of colon Lower gastrointestinal C19 Malignant neoplasm of rectosigmoid junction Lower gastrointestinal C20 Malignant neoplasm of rectum Lower gastrointestinal C21 Malignant neoplasm of anus and anal canal Lower gastrointestinal C26 Malignant neoplasm of other and ill-defined Lower gastrointestinal digestive organs C33 Malignant neoplasm of trachea Lung C34 Malignant neoplasm of bronchus and lung Lung C35 Malignant neoplasm of thymus Lung Faster cancer treatment indicators data definitions and reporting for the indicators 30

31 C38 Malignant neoplasm of heart, mediastinum and Lung pleura, heart C39 Malignant neoplasm of other and ill-defined Lung sites in the respiratory system and intrathoracic organs C45 Mesothelioma Lung C40 Malignant neoplasm of bone and articular Sarcoma cartilage of limbs C41 Malignant neoplasm of bone and articular Sarcoma cartilage of other and unspecific sites C46 Kaposi s sarcoma Sarcoma C48 Malignant neoplasm of retroperiotneum or Sarcoma peritoneum C49 Malignant neoplasm of other connective or soft Sarcoma tissue C43 Malignant melanoma of skin Skin C44 Other malignant neoplasms of skin (except Skin basal cell carcinoma) C47 Malignant neoplasm of peripheral nervous and autonomic nervous system Brain / Central nervous system C69 Malignant neoplasm of eye and adnexa Brain / Central nervous system C70 Malignant neoplasm of meninges Brain / Central nervous system C71 Malignant neoplasm of brain Brain / Central nervous system C72 Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous system Brain / Central nervous system C50 Malignant neoplasm of breast Breast C51 Malignant neoplasm of vulva Gynaecological C52 Malignant neoplasm of vagina Gynaecological C53 Malignant neoplasm of cervix uteri Gynaecological C54 Malignant neoplasm of corpus uteri Gynaecological C55 Malignant neoplasm of uterus, part unspecified Gynaecological C56 Malignant neoplasm of ovary Gynaecological C57 Malignant neoplasm of other and unspecified Gynaecological female genital organs C58 Malignant neoplasm of placenta Gynaecological C60 Malignant neoplasm of penis Urological C61 Malignant neoplasm of prostate Urological C62 Malignant neoplasm of testis Urological C63 Malignant neoplasm of other and unspecified Urological male genital organs C64 Malignant neoplasm of kidney, except renal Urological pelvis C65 Malignant neoplasm of renal pelvis Urological C66 Malignant neoplasm of ureter Urological C67 Malignant neoplasm of bladder Urological C68 Malignant neoplasm of other and unspecified Urological urinary organs C74 Malignant neoplasm of adrenal gland Other C75 Malignant neoplasm of other endocrine glands Other Faster cancer treatment indicators data definitions and reporting for the indicators 31

32 and related structures C76 Malignant neoplasm of other and ill-defined Other sites C78 Secondary malignant neoplasm of respiratory Other and digestive organs C79 Secondary malignant neoplasm of other sites Other C80 Malignant neoplasm without specification of Other site C97 Malignant neoplasms of independent (primary) Other multiple sites C81 Hodgkin s disease Haematological C83 Diffuse non-hodgkin s lymphoma Haematological C84 Peripheral and cutaneous T-cell lymphomas Haematological C85 Other and unspecified types of non-hodgkin s Haematological lymphoma C88 Malignant immunoproliferative diseases Haematological C90 Multiple myeloma and malignant plasma cell Haematological neoplasms C91 Lymphoid leukaemia Haematological C92 Myeloid leukaemia Haematological C93 Monocytic leukaemia Haematological C94 Other leukaemia of specified cell type Haematological C95 Leukaemia of unspecified cell type Haematological C96 Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related tissue Haematological Faster cancer treatment indicators data definitions and reporting for the indicators 32