OGC P09 Benchmarking of OG cancer care across the United Kingdom: a collaboration of 2 national clinical audit systems

Abstract

Abstract Background Clinical audit plays an important role in benchmarking cancer services to ensure the delivery of high-quality care. The UK has 2 separate clinical audits (NOGCA in England and Wales, and QPI data in Scotland) analysing the process and outcomes of care for oesophagogastric (OG) cancer patients. Both cover the care pathway from diagnosis to the end of primary treatment. Comparative analysis has not previously been undertaken between these 2 audits. We aim to demonstrate that the 2 systems can be interrogated to provide valuable population and benchmarking data, and present the results of a successful collaborative project. Methods Data was extracted from the 2 audits for all epithelial OG cancers diagnosed between 01/01/17 and 31/12/19 (n=34,584). Analysis was then undertaken, with a particular focus on: 1) disease stage at presentation; 2) proportion of patients undergoing CT staging 3) proportion of patients receiving curative/non-curative treatment; 4) Curative treatment patterns; and 5) short-term outcome measures (adjusted mortality, key pathology outcomes). Descriptive statistics were derived for each country and stratified by patient/tumour characteristics. Mortality rates and longitudinal margins were adjusted for case-mix using multiple logistic regression. Statistical tests were 2-sided; threshold of significance set at p<0.05. Results Baseline demographics were similar. Staging CTs were less commonly performed in England (83.1%; Scotland=98.5%; Wales=92.2%). Metastatic disease at presentation was highest in Scotland (40%-42%; England=30%-34%; Wales=36%-39%). England (40%) had highest proportion of MDT derived curative treatment plans (compared to Scotland=29% and Wales=34%). However, actual curative treatment rates (24-31%) were more similar and these differences narrowed after correction for population and staging differences. Curative treatment patterns are shown in Table 1. Mortality rates were similar in the 3 nations. Longitudinal margin positivity was significantly lower in Scotland (2.4%; England=5.4% and Wales=8.2%). Excision of >15 lymph nodes was highest in England. Conclusions The 2 audit systems used in the UK to analyse the care and outcomes for patients diagnosed with OG cancer share sufficient data definitions and overlap to allow meaningful comparison. The data presented here represents an important benchmark of current UK OG practice. Most results were similar although some important differences were highlighted which require further exploration.