National Audit of Breast Cancer in Older Patients (NABCOP) context page

• CQC have collaborated with audit bodies and agreed to present these ‘key’ metrics about the quality of services.
• This document provides guidance to assist interpretation of the key metrics from the National Audit of Breast Cancer in Older Patients, run by the Association of Breast Surgery and the Royal College of Surgeons. Full audits can be reviewed where it is necessary to further inform an inspection.
• A total of 124 NHS trusts in England participated during the Jan-Dec 2017 period.

Metrics

Proportion of patients with recorded ER status

• Rationale: This metric shows the proportion of patients with invasive breast cancer who have their oestrogen receptor (ER) status recorded. The results of ER assessment should be available and recorded at the multidisciplinary team meeting when decisions about systemic treatment is made. This is necessary for appropriate treatment decisions to be made for patients with invasive disease.
• Guideline/mapping: Maps onto NICE NG101.
• Graph/relative performance: Audit standard – 90%. The Benchmarking method is a 4 point scale. The target data completeness for this measure is 100%. Data quality has been assigned a score on a 4-point scale: Amber 0-50%, yellow, 50-80%, light green 80-90%, and a green star for those achieving 90-100%. Data completeness lower than 50% (amber) is insufficient. Data completeness between 50 and 80% (amber) is low. Data completeness above 90% is considered good and sufficient, and providers in this category should be aiming to have 100% data completeness.
• Quality improvement prompt question: How is the hospital ensuring that the ER status is assessed & recorded and uploaded to the national cancer registration services?

Proportion of patients with recorded HER2 status

• Rationale: This metric shows the proportion of patients with invasive breast cancer who have their human epidermal growth receptor 2 (HER2) hormone status recorded. The results of HER2 assessments should be available and recorded at the multidisciplinary team meeting when guidance about systemic treatment is made. This is necessary for appropriate treatment decisions to be made for patients with invasive disease.
• Guideline/mapping: Maps onto NICE NG101.
• Graph/relative performance: Audit standard – 90%. The benchmarking method is a 4 point scale. The target data completeness for this measure is 100%. Data quality has been assigned a score on a 4-point scale: Amber 0-50%, yellow, 50-80%, light green 80-90%, and a green star for those achieving 90-100%. Data completeness lower than 50% (amber) is insufficient. Data completeness between 50 and 80% (amber) is low. Data completeness above 90% is considered good and sufficient, and providers in this category should be aiming to have 100% data completeness.
• Quality improvement prompt question: How is the hospital ensuring that the HER2 status is assessed & recorded and uploaded to the national cancer registration services?

Proportion of patients with recorded TNM stage

• Rationale: This refers to the proportion of patients with invasive disease who have TNM stage recorded. TNM stage refers to the staging system. T relates to size and extent of main tumour, N relates to number of local lymph nodes with cancer, M refers to whether the cancer has metastasized. It is vital it is recorded to manage invasive disease.
• Guideline/mapping: None.
• Graph/relative performance: Audit standard – 90%. The benchmarking method is a 4 point scale. The target data completeness for this measure is 100%. Data quality has been assigned a score on a 4-point scale: Amber 0-50%, yellow, 50-80%, light green 80-90%, and a green star for those achieving 90-100%. Data completeness lower than 50% (amber) is insufficient. Data completeness between 50 and 80% (amber) is low. Data completeness above 90% is considered good and sufficient, and providers in this category should be aiming to have 100% data completeness.
• Quality improvement prompt question: How is the hospital ensuring that the following information is assessed & uploaded to the national cancer registration services: T stage, N stage, M stage? Tumour size should be consistent with the T stage.

Proportion of patients with recorded performance status

• Rationale: This refers to the proportion of patients who have performance status recorded (within 3 months around diagnosis, and prior to treatment being started). Performance status refers to the ECOG scale of performance status, which is widely used to quantify the functional status of cancer patients, and is an important factor in determining prognosis and treatment.
• Guideline/mapping: None.
• Graph/relative performance: Audit standard – 90%. The benchmarking method is a 4 point scale. The target data completeness for this measure is 100%. Data quality has been assigned a score on a 4-point scale: Amber 0-50%, yellow, 50-80%, light green 80-90%, and a green star for those achieving 90-100%. Data completeness lower than 50% (amber) is insufficient. Data completeness between 50 and 80% (amber) is low. Data completeness above 90% is considered good and sufficient, and providers in this category should be aiming to have 100% data completeness.
• Quality improvement prompt question: How is the hospital ensuring that the following information is assessed & uploaded to the national cancer registration services: WHO performance status?

Proportion of patients receiving a triple diagnostic assessment in a single visit

• Rationale: This metric shows the proportion of patients who received a triple diagnostic assessment in a single visit, of those patients with suspected breast cancer who are referred to specialist services and are subsequently diagnosed with early invasive breast cancer. Triple diagnostic assessment is the standard diagnostic method in the breast clinic and includes clinical assessment, mammography and/or ultrasound imaging, and core biopsy and/or fine needle aspiration cytology. It is best practice to carry out all of these assessments at the same visit as it reduces the burden on the patient and allows for quick diagnosis and therefore prompt treatment and better outcomes. The NABCOP calculates the receipt of ‘triple diagnostic assessment in a single visit’ based on the dates of imaging and biopsy being the same.
• Guideline/mapping: Maps onto NICE NG101 and NICE QS12.
• Graph/relative performance: Audit standard – 90%. The benchmarking method is a percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: How is the hospital ensuring that women are able to receive all components of triple diagnostic assessment at their initial clinic visit after referral for suspected breast cancer, in line with NICE recommendations? How is the hospital reviewing and, where necessary, improving the process of submitting, to the national cancer registration services, the dates of assessment for all investigations performed at a triple assessment clinic?

 Proportion of patients seen by a breast clinical nurse specialist

• Rationale: This metric shows the proportion of patients seen by a breast clinical nurse specialist of patients diagnosed with ductal carcinoma in situ (DCIS) or invasive breast cancer. All patients with breast cancer should be assigned to a named breast clinical nurse specialist who will support them throughout diagnosis, treatment and follow up.
• Guideline/mapping: Maps onto NICE NG101 and NICE CG81.
• Graph/relative performance: Audit standard – 100%. The benchmarking method is a percentile RAG scale; hospitals have been graded according to whether their outcomes fall in the top 25%, bottom 25%, or in the middle range of trusts nationally.
• Quality improvement prompt question: How is the hospital ensuring that women are assigned a named breast clinical nurse specialist (CNS) to provide information and support? How is the hospital ensuring that data on the assignment of a named breast CNS is submitted to NCRAS and that their figures agree with those reported by the cancer patient experience survey?