AUDIT RESULTS SUMMARY January 1st – 31st December 2000
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AUDIT RESULTS SUMMARY January 1st – 31st December 2000

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THE BRITISH ASSOCIATION OF UROLOGICAL SURGEONS SECTION of ONCOLOGY BAUS Cancer Registry Analyses of Minimum data set for Urological cancers st stJanuary 1 – 31 December 2008 October 2009 MEMBERS OF THE EXECUTIVE COMMITTEE M Aitchison G Boustead J Crew D R Greene R C Kocklebergh G S McIntosh R A Persad S Prescott V Srinivasin K S Swami PRODUCED FOR BAUS SECTION OF ONCOLOGY by Mrs Sarah Fowler BAUS Cancer Registry Manager CONTENTS Page Number Introduction 1 Results Summary & Methods of analysis 2 A. Participants and Overall Figures 3 Charts 1 – 17 B. Times between Referral, First Consultation, Diagnosis and 13 Definitive Treatment Charts 18 – 22 C. Histology & Staging 1 6 Charts 23 – 29 D. Initial Treatment Intention & Laparoscopic Surgery 20 Charts 30 - 34 E. Clinical Trial Status & Discussion at MDT meeting 23 Charts 35 – 36 F. Completeness of Data 24 Charts 37 – 38 G. Bladder cancers 1999 – 2008 25 Charts 39 – 47 H. Cystectomies 2004 – 2008 30 Charts 48 – 57 Appendix – Participating Hospitals over the Years 1998-2008 36 INTRODUCTION ...

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     THE BRITISH ASSOCIATION OF  UROLOGICAL SURGEONS 
   SECTION of ONCOLOGY          BAUS Cancer Registry Analyses of Minimum data set for Urological cancers January 1st–31stDecember 2008  October 2009
 
            
M
EM
  
BERS OF THE EXECUTIVE COMMITTEE   M Aitchison G Boustead J Crew D R Greene  R C Kocklebergh G S McIntosh R A Persad S Prescott  V Srinivasin K S Swami                          
 
P
ROD
  
                     UCED FOR BAUS SECTION OF ONCO by  Mrs Sarah Fowler BAUS Cancer Registry Manager
L
OG
Y
 
 
 
 
  
    
 
CONTENTS
 
Introduction  Results Summary & Methods of analysis  A. Participants and Overall Figures  Charts 1 – 17  B. Times between Referral, First Consultation, Diagnosis and Definitive Treatment  Charts 18 – 22   C. Histology & Staging  Charts 23 – 29  D. Initial Treatment Intention & Laparoscopic Surgery  Charts 30 - 34  E. Clinical Trial Status & Discussion at MDT meeting  Charts 35 – 36  F. Completeness of Data  Charts 37 – 38  G. Bladder cancers 1999 –2008  Charts 39 – 47  H. Cystectomies 2004 – 2008  Charts 48 – 57  Appendix –Participating Hospitals over the Years 1998-2008  
 
Page Number  1
2
3
13
16
20
23
24
25   30
36
 
 
 
INTRODUCTION  The registry has now reached its 12thyear of data collection. The last year has seen significant changes with the introduction of the new web based database. While the original database has served BAUS and the section well, our hope is that Nuvola will improve access and capture rates as well as simplify data returns demanded for revalidation and licensing.  The format of the annual report has been changed slightly to reflect the maturity and size of the database, which now holds data on over 270 000 new cancers. This year we have attempted to look at trends over the last decade, using reference years due to the large amount of data. In a number of instances this has revealed evidence of significant stage migration. In line with the theme of this year’s Section meeting, we have also included some analyses of the whole dataset on bladder cancer over the last decade, as well as data on cystectomy over the last 5 years.  Returns from 2008 are marginally up on last year, but unfortunately the quality of the submissions has declined. The reasons for this appear to be data entered by a variety of people apart from consultants or SpR’s, including data managers, CNS’s, MDT co-coordinators to mention a few. In addition the increasing use of in-house systems to populate our datasets has led to some large gaps in completion. The old adage of “rubbish in, rubbish out” applies so please impress upon those in your departments who do data entry the importance of accuracy and completeness.  The most notable trends detected in the latest analysis, shows continuing age and stage migration in prostate cancer, with the median age at diagnosis declining further and more localized disease being detected. Of most interest is the marked stage migration in renal cancer, with T1 tumours increasing significantly and steadily over the past decade, while T2 tumours declined and T3/4 cancers remaining steady. As always this results in many more questions than answers. The initial analysis of 70 000 bladder cancers has given us excellent insight into bladder cancer therapy in the UK. While the BCR holds valuable epidemiological data, meaningful outcome date is lacking.  On behalf of the Section of Oncology, I would like to thank Mr Gregor McIntosh for his hard work over the last five years overseeing the registry. As always a huge thank you goes to Sarah Fowler for all her hard work, particularly in relation to the move from the Access based registry to Nuvola, which has created lots of additional work.  Finally, the Executive committee would like to see regular publications and updates appearing in the peer reviewed literature, to raise the profile and awareness of the BCR, as well as utilize the valuable information it holds. Anyone is free to apply with a simple application form and instructions available on the website.  Greg Boustead October 2009
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AUDIT RESULTS SUMMARY January 1st–31stDecember 2008 Who took part?  391 consultant urologists from 107 hospital centres in England, Wales, Scotland and Northern Ireland provided data for this study submitting data on 25,839 newly presenting urological tumours from 1st January to 31stDecember 2008. These figures represent approximately 46% of the total UK tumours registered in 2006/2007 (56,096) (the most recent years available). 1.2% (318/25839) are the private patients of 65 consultants.  How were the data analysed?  Information obtained from consultants was entered into the computer database using unique identifying numbers for individual consultants or, if they preferred, a centre number. Twelve centres returned data under a centre number only (29 consultants in total).  Data could be returned either in electronic format using either an Access (Microsoft) database, the new web-based database launched in June 2009 or in-house” database (23,767 – 92% of returns) designed for the purpose or by completion of a pro forma for each patient (8% of returns). The pro formas were entered directly into an Access database, at which time validation comprising mainly of checks for duplicate entries and on dates and sex of patient could be carried out. 103 tumours were registered twice as a tertiary referral from another centre or another consultant in the same centre. They were only included once in all the analyses using the data from the primary site for all analyses except those relating to staging and treatment when the tertiary site data was used. In addition 28 benign tumours were registered but these have been excluded from all analyses.  The data presented here are a summary of the data received up to 4thSeptember 2009 and relate to diagnoses made during the whole of 2008. The following data was included (this includes the total returns):  a. Patients for who the date of diagnosis fell within the time period. (01/01/2008 to 31/12/2008). 25,215 registrations (97.1%). b. diagnosis was either not included or the patient was a tertiary referral, but thePatients for whom the date of referral date fell within the study period. (01/01/2008 to 31/12/2008) 685 registrations (2.6%). c. Patients for whom the diagnosis and referral dates were either not included or the patient was a tertiary referral, but the date of first consultation fell within the study period. (01/01/2008 to 31/12/2008). 58 (0.2%).  For the ranked charts (1, 2 & 4) the individual consultant or centre identification numbers were removed and replaced with rank numbers starting at 1. A unique, confidential "Ranking Sheet" was prepared for each surgeon to enable them to identify their rank in every chart. For those charts where overall figures for the entire database are shown the ranking sheet displays the consultant’s individual figures. No one else can identify the results of an individual consultant. The ranked comprise single bars, with in addition the 25, 50, and 75 percentiles and are ranked from left to right in the ascending order of the data item being measured. Where percentages are included figures have been rounded up to one decimal point. Unless otherwise stated all analyses represent the 2008 dataset.  A personal ranking sheet for each consultant registering three or more tumours was issued individually to go with this chartbook.  Sarah Fowler October 2009 BAUS Cancer Registry (BCR) Manager  
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A.  Participants and Overall Figures    The number of centres using their own in-house systems to return data has increased yet again but unfortunately the completeness of data returned by many of these systems remains less so than when returned using the specially designed Microsoft Access database making validation and analyses more complicated. It is to be hoped that many these problems will be resolved as the switch to the new web-based database becomes mandatory from January 2010.  As in previous years we have incorporated comparison with National Cancer Statistics from 2006/2007 – the latest years available. Comparison with the national data does suggest that our data are representative of the UK as a whole. However when comparing our data with that of the national data we should bear in mind the following:   Our data are only being collected by urologists. We have no way of estimating the number of urological cancers that are not being seen or diagnosed by urologists. In the case of kidney cancer, it seems that a substantial number are never seen by a urological surgeon. These data are being presented within ten months of the completion of the year of data collection and  being compared to projected national figures from 2006/2007, which are the latest to be published.  majority of participants, there is no specific funding for data collection and the analysis andFor the presentation is entirely funded by the Section of Oncology.  
 
 
BAUS - Register of Newly Presenting Urological Tumours January 1st - December 31st 2008 Who took part
390 Consultants from 107 Centres provided data on 25,839 newly presenting urological tumours.
1.2% (318/25839) were from the private patients of 65 Consultants
Range of Consultants per Centre = 1 - 12, (Median 4)
Median number of tumours per Consultant = 44, Range 1 - 239
Median number of tumours per Centre = 212, Range 3 - 952  
92% (23767/25839) of the data were returned electronically
3
 
N.B. Excludes data returned by centres as a whole
301 321
Chart 2
341
Total Number of Tumours Reported 1000 90025th centile
Total Number of Newly Presenting Tumours Reported per Centre Median: 212 (Interquartile Range 112 - 325)
800
600
700
400
500
200 100
300
41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 Total Registrations Centre Ranking
0 1 5 9 13 17 21 25 29 33 37
N.B. Excludes private patients
 
Median
75th centile
4
Ch
 
 
261 281
141 161 181 201 221 241 Total Registrations Consultant Ranking
121
0 1 21 41 61 81 101
50
100
150
200
75th centile
250
Total Number of Tumours Reported 25th centile
Median
Total Number of Newly Presenting Tumours Reported per Consultant Median: 44 (Interquartile Range 17 - 83)
Chart 3
 
Chart 4
Number of Newly presenting Tumours by Organ per Consultant 391 Consultants reported 25, 839 Tumours Median Total per Consultant = 44
Urethra   
Reported
Consultant
* Includes 78 registrations with High Grade PIN only
Total Number of Newly Presenting Tumours Reported per Consultant by Organ where n >=44 (i.e. the median reported per consultant) 280 75th Median centile25th centile
240
200
160
120
80
40
0 1 8 15 22 29 36 43 50 57 64 71 78 85 92 99 106 113 120 127 134 141 148 155 162 169 172 Consultant Ranking Prostate Bladder Kidney Other N.B. Excludes data returned by centres as a whole
5
 
 
Chart 5
 
Chart 6
  
Organ
Number Recorded
Overall Data by Organ
Percentage of Mean Age Total (25839) Age at Range Diagnosis  
* Includes 78 registrations with High Grade PIN only
  
Males
Overall Data by Organ by Year
Number
% of Total
Recorded
Including registrations with High Grade PIN only: * 78; # 84
6
% of Total
Number
Females
% of Total
 
 
Chart 7
Chart 8
   
  
Total Registrations per Country Prostate, Bladder, Kidney, Testis, Pelvis/Ureter & Penile Tumours*
Total Registrations* National BAUS %
BAUS %
**England : cancer statistics - registrations of cancer diagnosed in 2006, England. Series MBI no. 37 –2009 Wales: Welsh Cancer Intelligence & Surveillance Unit - 2007 Scotland:Scottish Cancer Registry,Scottish Cancer Intelligence Group, ISD Scotland - 2006 Northern Ireland:Northern Ireland Cancer Registry - 2006 -crnik/.uacb..wuqww
25
20
15
10
5
BAUS %
Percentage Age Distribution - Prostate Tumours BAUS 2008 median: 71 Years; Range 29 -105 (n= 14,115*) BAUS 2004 median: 72 Years; Range 21 -103 (n= 14,665*) BAUS 1999 median: 73 Years; Range 21 -100 (n= 8,870*)
Percentage in each age group
0 <40 40-49 50-59 60-64 65-69 70-74
2008 2004 1999
Age could be calculated when both date of birth and diagnosis date were recorded The reductions in age at diagnosis over the years are significant at the 95% CI
 
7
75-79
80-84
>=85
 
 
Chart 9
 
Percentage Age Distribution - Bladder Tumours - Males BAUS 2008 median: 73 Years; Range 19 -103 (n= 4,814*) BAUS 2004 median: 73 Years; Range 20 -101 (n= 4,470*) BAUS 1999 median: 72 Years; Range 6 - 99 (n= 4,664*)
Percentage in each age group
45 40 35 30 25 20 15 10 50.8 1.1 1.1 0 <40
24 24.1 24.9
10 8.1 9.6 .4
2.8 3.2 2 8 . 40-49 50-59 60-69 2008 2004 1999
* Age could be calculated when both date of birth and diagnosis date were recorded
Chart 10
39.2 37 36.9
70-79
27 25.2 21.8
>=80
Percentage Age Distribution - Bladder Tumours - Females BAUS 2008 median: 73 Years; Range 19 -103 (n= 4,814*) BAUS 2004 median: 73 Years; Range 20 -101 (n= 4,470*) BAUS 1999 median: 75 Years; Range 2 - 98 (n= 1,590*)
Percentage in each age group
22.3 19.6 20.2
40 35 30 25 20 15 109.2 9.4 7.8 3.72.7 5 2.61.3 1.1 1.7 0 <40 40-49 50-59 60-69 2008 2004 1999 * Age could be calculated when both date of birth and diagnosis date were recorded
8
37.7 34.7 32.1
70-79
32.6 29.4 29.4
>=80