Dr Sarah Treece Peterborough City Hospital North West Anglia NHS Foundation trust Background NG2 It is stated that there is considerable variation across the NHS in the diagnosis and management of bladder cancer and the provision of care to people who have it ID: 912059
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Slide1
RCR National Audit of Muscle Invasive Bladder Cancer (MIBC) – Initial Results
Dr Sarah
Treece
Peterborough City Hospital
North West Anglia NHS Foundation trust
Slide2Background
Slide3NG2
It is stated that there is:
considerable variation across the NHS in the diagnosis and management of bladder cancer and the provision of care to people who have it
there is evidence that the patient experience of people with bladder cancer is worse than that for people with other cancers
Slide4Bladder Cancer Survival
Slide5Audit Aims
To
assess the patient
pathway
To determine the penetration of best practice
treatments
Neo-adjuvant chemotherapy
Radiosensitisers
To assess current
radiotherapy practice and the quality
of bladder cancer radiotherapy in the
UK
Including the availability
of newer RT
technologies
Link
with BAUS database, to concurrently capture data on patients undergoing cystectomy
Slide6Audit Aims
To
assess the patient
pathway
To determine the penetration of best practice
treatments
Neo-adjuvant chemotherapy
Radiosensitisers
To assess current
radiotherapy practice and the quality
of bladder cancer radiotherapy in the
UK
Including the availability
of newer RT
technologies
Link
with BAUS database, to concurrently capture data on patients undergoing cystectomy
Ultimately,
to
improve outcomes for our
patients
Slide7Audit – inclusion criteria
All patients receiving radical or palliative radiotherapy for muscle invasive bladder cancer
Data collected during a 16 week period from 5/12/17- 27/03/17
Electronic submission using Survey Monkey
Slide8Results
35 Radiotherapy centres have submitted data (as of 14/6/17)
Total cases = 395
Completed cases = 367
Radical 209
Palliative 158
Slide9Results – Radically Treated Patients
Average age =
74 (range 47-91)
M:F = 3:1
WHO Performance Status:
Slide10Results – Radically Treated Patients
90% TCCs (Transitional Cell Carcinomas)
Most Grade 3
Histopathological staging:
pT2 at least
Radiological staging:
majority T2/T3 and node negative
Some node positive patients treated radically
Slide11NG2 - Imaging
1.2.9 Offer CT or pelvic MRI staging to people diagnosed with MIBC that is being assessed for radical treatment
1.2.10 Consider CT urography, to detect upper tract involvement
1.2.11 Consider CT of the thorax
1.2.12 Consider PET‑CT if there are indeterminate findings on CT or MRI, or a high risk of metastatic disease (
eg
. T3b disease).
Slide12Was pelvic staging performed?
Slide13Was CT chest performed?
Slide14How was the upper tract imaged?
Slide15NG2 – Treatment Decisions
1.5.1 Ensure that a specialist urology multidisciplinary team reviews all cases of MIBC
1.5.3 Offer a choice of cystectomy or radiotherapy to people with MIBC for whom radical therapy is suitable. Ensure that the choice is based on a full discussion between the person and a urologist who performs radical cystectomy, a clinical oncologist and a clinical nurse specialist
Slide16Was the patient discussed at a local specialist urology MDT?
Was the patient discussed at a network specialist urology MDT
?
Has the patient seen an oncologist with a subspecialty interest in bladder cancer?
Has the patient seen a urologist who specialises in cystectomy?
Slide17Was cystectomy discussed?
Slide18Patient Pathway
Pathway steps
Average
time (days)
TURBT to histology report
5
TURBT to definitive treatment (neo-adjuvant chemotherapy, or radiotherapy start)
57
Referral for
radiotherapy to radiotherapy treatment start
21
Slide19NG2 – NeoAdjuvant
Chemotherapy
Offer neoadjuvant chemotherapy using a cisplatin combination regimen to people with MIBC for whom cisplatin‑based chemotherapy is suitable
Slide20Was neoadjuvant chemotherapy given?
Slide21Neoadjuvant chemotherapy used
Slide22NG2 - Radiosensitisers
1.5.8 Use a
radiosensitiser
(such as
mitomycin
in combination with fluorouracil [5‑FU], or
carbogen
in combination with nicotinamide) when giving radical radiotherapy
Slide23Was radiotherapy delivered with a radiosensitiser
?
Slide24Radiosensitiser used
Slide25RCR Radiotherapy Dose Fractionation Document
60-64Gy in 30-32# over 6-6.5w
52.5-55Gy in 20# over 4 weeks
Slide26How was the target defined?
Slide27What margin was used for CTV to PTV? (cm
)
Slide28Treatment technique
Slide29Which critical structures were considered in planning?
Slide30Was compensation for bladder filling/ motion used?
No – 9.2%
Yes
Accounted for in CTV to PTV margin - 31%
Plan of the day – 7.1%
Image guidance – 49%
Other – 3.6%
Slide31Treatment verification used
Slide32Was the patient treated in a trial?
Slide33Conclusions
Data is incomplete
Deadline for submitting data was end May
Some Trusts have asked for a further extension due to IT problems in NHS
Need to await final results
Slide34Acknowledgements
Mr Karl Drinkwater, RCR Audit Officer
Dr
Mohini
Varughese
, Co-Lead on Bladder Audit project
RCR QI and Audit Committee
All trust Audit Leads and radiotherapy staff involved in submitting data