All cancer services reviewed are assessed against a set of quality measures, specific to the cancer type. You can find the measures for each cancer type below.
Each set of measures has been developed and agreed nationally by expert groups for each tumour site e.g. lung cancer and also for services that support cancer care/treatment such as radiotherapy/chemotherapy or palliative care.
The measures are based on implementing the Improving Outcomes Guidance (IOG), written by the National Institute for Health and Clinical Excellence (NICE). If you would like to know more about the IOG, please visit the NICE website www.nice.org.uk/guidance
The measures comprise the common sense ‘generic’ aspects of patient centred care that specify how an MDT should function and the structures needed to for effective MDT working, e.g. all patients newly diagnosed with cancer should be discussed in a multi-disciplinary setting, be allocated a key worker and receive appropriate, easy to understand information about their cancer.
Tumour specific measures have also been written to represent ‘best practice’ in terms of diagnostic, treatment and follow up guidelines. If MDTs follow these guidelines patients can be assured they are receiving the most appropriate diagnostic tests and treatment for their cancer type, which is consistent across the country.
The measures are used to assess and measure the quality of cancer services; teams are required to determine compliance with each individual measure and identify any gaps or shortfalls. However compliance with the measures does not necessarily guarantee good outcomes, as some teams may have poor compliance but good outcomes. This scenario is often due to a lack of evidence regarding working practices that underpin safe quality care. Conversely an MDT with high compliance, but poor outcomes could be because patients wait too long before going to their GP with symptoms of cancer, or there is a lack of specific expertise in the team.
In essence the measures help to:
- Establish whether care/treatment is as safe as possible
- Improve the quality and effectiveness of care
- Improve the patient and carer experience
This should result in the right staff, with the right skills, undertaking the right care/treatment, in the right place and at the right time. Collectively these ’rights’ constitute good governance of cancer services.
If you would like to see details of specific measures please search below for your cancer type. You will notice that the measures are arranged in groups for each topic to represent different aspects of a service and the responsibilities attached to each, i.e. Network Groups that ensure consistency of care/treatment across a group of hospitals and Multi-Disciplinary Teams (MDTs) or Departments that provide or support the delivery of best practice.
Reports for all cancer services listed below are available on My Cancer Treatment.
Brain and CNS Measures
Brain tumours can be primary, starting in the brain or secondary where a tumour has spread to the brain from another part of the body. Any mass or growth of abnormal cells occurring in the brain tissue, skull, supportive tissue around the brain, cranial nerves, or the pituitary or pineal gland can be a brain tumour.
There are dozens of classifications for brain cancers, based on where in the brain they arise and how they grow. Some of the terms for individual brain tumours you may come across can be baffling and often hard to pronounce, but patient friendly information, explaining these terms in easy to understand language is available from brain and CNS MDTs, (usually the nurse specialist).
Although brain tumours can develop at any age, the risk increases as we get older. However, some types of brain tumour are more common in younger adults and children.
Patients with a brain tumour are referred to a specialist neurosciences MDT; this is a team based in a designated centre that has all the staff and facilities necessary for performing brain surgery, along with all the immediate post-operative care and support that goes with it.
The measures set out quality standards for the whole patient care pathway, which in some circumstances means patients may receive treatment in a variety of settings in different hospitals to get the best possible outcome. However, the route through a pathway should always be based on patient need.
Given the nature of brain and CNS cancers, there should be area wide arrangements and strict procedures for emergency surgery for patients with undue pressure in the skull or on the spinal cord.
Appropriate support systems are also essential to prepare patients and carers for treatment, follow up, rehabilitation and symptom control. Psychological support, specialist neurological rehabilitation and specialist palliative care are key support systems, which are likely to be needed at all stages of the patient pathway.
Breast cancer is the most common cancer in the UK. About 48,000 women get breast cancer in Britain each year. Most (8 out of 10) are over 50, but younger women, and in rare cases, men, can also get breast cancer.
There are several different types of breast cancer and knowing the type helps the multi-disciplinary team plan the most appropriate treatment for patients.
The measures aim to ensure speedy and efficient initial referral and appropriate diagnostic tests so that optimal treatment can be started. All women with a breast problem should be referred to the local breast MDT and be seen within two weeks.
The MDT should comprise members who have the skills and expertise to offer a comprehensive service that involves rapid diagnosis, which should include HER2 testing as the cells in this type of cancer grow differently, which influences the treatment options; a range of treatment options including immediate breast reconstruction; referral for psychological support if required and formal arrangements to support women whose cancer has spread to other parts of the body (metastatic disease).
Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. There are different groups of anti-cancer drugs that can be used. The main group that many people think of as ‘chemotherapy’ is cytotoxic chemotherapy. Cytotoxic means toxic or damaging to cells.
Chemotherapy can be used to try to cure cancer completely; to help make other treatments more effective e.g. it can be combined with radiotherapy, or used before surgery; to relieve symptoms and slow the spread of the condition and reduce the risk of the cancer returning after surgery or radiotherapy
Chemotherapy measures describe the structures, processes and resources that support high quality, safe practice. They include specialist training for staff involved in the storage, preparation, and administration of chemotherapy drugs, including intrathecal (into the spine); creating the right environment for administering the drugs and providing appropriate support for patients prior to, during and after chemotherapy. Staff and patients/carers are also alert to the complications of chemotherapy, including neutropenic sepsis, which is a medical emergency.
Colorectal cancer includes cancer of the colon, rectum and anus, and is the third most common cancer in the UK. Approximately 72% of bowel cancer cases develop in people who are 65 or over. Two-thirds of bowel cancers develop in the colon, with the remaining third developing in the rectum. The walls of the colon and rectum are made up of layers of body tissue and most tumours start in the innermost lining of the bowel and develop from small growths called polyps.
The measures aim to ensure speedy and efficient initial referral and diagnosis for patients and to use modern technology e.g. endoscopy for the primary diagnostic. Where appropriate, patients should be offered ‘key hole’ surgery the technical term for which is ‘laparoscopy’.
The MDT should comprise members who have the skills and expertise to provide a comprehensive service, with detailed arrangements for emergency admissions and referral to other teams e.g. liver if the cancer has spread to other organs. Local MDTs do not treat anal cancers as there is a requirement for patients to be referred to a specialist MDT.
A group of cancers are classified under the label ‘gynaecology’, they are ovarian, endometrial (the lining of the womb) cervix, vagina and vulva (external part of the vagina). Although rare, cancer can also occur in the fallopian tubes.
The most common gynaecological cancers are found in the uterus (womb) and ovaries. Most ovarian cancers are a type called epithelial cancer, which means the tumour has started in the cells that cover the surface of the ovary. Cervical cancer is less common and is usually the result of a common infection from the human papilloma virus (HPV) that can affect the cells of the cervix.
Gynaecology cancer measures identify three levels of service delivery, comprising diagnostic teams and local and specialist MDTs. These services are required to work closely together to ensure care/treatment is consistent, well-coordinated and undertaken by the right team, in the right place and without delays.
The measures outline what each of the above services is responsible for, including the scope for the treatment of patients outside the specialist MDT. This includes acceptable options for the care pathway of patients with low risk endometrial cancer and for patients who have had a biopsy of the cervix.
The haematological cancers – leukaemia (acute and chronic), lymphoma and Hodgkin’s disease and myeloma – are cancers arising from abnormal blood or bone marrow cells. They are rare diseases, accounting for less than 5% of all registered cancers but there are still around 30,000 patients a year being diagnosed and anyone can get a blood cancer at any age. With modern chemotherapy treatments, the great majority of patients go into remission and an increasing number of patients are cured.
The haematology measures aim to ensure speedy and efficient initial referral and appropriate diagnostic tests so that optimal treatment can be started. The measures take into account new national guidance for developing centralised haematology diagnostic services for consistent and accurate diagnosis. This is important as a precise diagnosis may well be the single most important aspect of improving outcomes in haematological cancers.
Some hospitals may have several different haematology MDTs and these may be known locally by the disease type which they deal with e.g. ‘lymphoma MDT’, ‘myeloma MDT’. The MDT should comprise members who have the skills and expertise to provide a comprehensive service, with detailed arrangements for on-going support for patients/carers throughout the pathway of care. This could include referral to centres that offer stem cell or bone marrow transplant where suitable; to palliative care to help patients cope with the symptoms of cancer; or a referral for psychological support.
Head and Neck Measures
Cancer can occur in any of the tissues or organs in the head and neck. There are over 30 different places that cancer can develop in this area, including the oral cavity, oropharynx, the nose, paranasal sinus and nasopharynx, the ear, salivary glands, the eye, the voice box (larynx) and the thyroid gland.
Head & neck cancers are uncommon and mostly occur in older people, with men affected more than women. Thyroid cancer is most likely to affect people who are middle-aged or older. However, one type of thyroid cancer (papillary) can occur in people younger than this. It is more common in women and uncommon in children.
Head & neck cancer measures set out clear requirements for rapid diagnosis and assessment prior to MDT discussion and for rehabilitation and support services. There are hospitals designated as referral points along with named clinicians to deal with diagnosis and initial assessment. All curative operations should be carried out by MDT members in a named hospital with a designated head & neck ward.
Given the nature of head & neck cancers, there is a need for strong support systems in preparation for treatment e.g. teeth and mouth checks, nutritional status and time with a clinical nurse specialist to ensure patients are fully prepared for their operation. Following treatment, ready access to appropriate rehabilitation services is essential to boost recovery.
Lung cancer is the second most common cancer in England and Wales. An estimated 40,800 new cases are diagnosed every year. Lung cancer is most commonly diagnosed in people who are 70–74 years old.
There are two main types of primary lung cancer, which behave and respond to treatment differently, small cell lung cancer and non-small cell cancer. About 15% of lung cancers (less than 1 in 5) are small cell; the rest are non-small cell.
Mesothelioma is a less common type of cancer that can affect the covering of the lungs. It often occurs in people who have been exposed to asbestos.
Secondary lung cancer describes the situation where cancer cells have spread to the lungs from a cancer that began elsewhere in the body.
The measures aim to ensure speedy and efficient initial referral and appropriate diagnostic tests so that optimal treatment can be started. It is important to have a chest surgeon member of a lung cancer MDT, who attends regularly, to ensure all patients who could benefit from surgery are offered the option.
The MDT should comprise members who have the skills and expertise to provide a comprehensive service, with detailed arrangements for on-going support for patients/carers throughout the pathway of care. This could include referral to palliative care to help patients cope with the symptoms of lung cancer; to a surgical team if surgery is an option or a referral for psychological support.
Radiotherapy is the use of high-energy x-rays and similar rays (such as electrons) to treat disease. Radiotherapy works by destroying cancer cells in the area treated. Although normal cells can also be damaged by radiotherapy, they can usually repair themselves.
Radiotherapy may be used to cure an illness by destroying a tumour; to control symptoms e.g. to relieve pain; before surgery to shrink a tumour to make it easier to remove or after surgery to destroy small amounts of tumour that may be left
The measures focus on providing optimal radiotherapy, delivered by specially trained health professionals in a safe patient friendly environment that has well maintained facilities. There is an emphasis on new technologies that include intensity modulated radiotherapy treatment (IMRT) and image guided radiation therapy (IGRT), for instance, and the measures reflect the need to adopt working practices which reflect new safety initiatives. There is more high tech terminology that is equally baffling, but information is available for patients in an easy to read and understand format from radiotherapy departments and/or clinical nurse specialists.
About 3000 people a year in the UK are diagnosed with a sarcoma, either soft tissue or bone. Primary bone cancer, originates in the bone, with around 600 cases diagnosed per year. Secondary bone cancer, which is a cancer that has spread from another part of the body, is more common.
Soft tissue sarcomas are cancers that occur in muscle, fat, blood vessels or any other tissues that support, surround and protect the organs of the body. They can also develop in specific organs such as the womb (uterus), stomach, skin and small bowel. Less commonly they may occur in the head and neck.
Bone sarcomas, such as osteosarcomas, start in the bone. These grow and develop differently and are treated differently from soft tissue sarcomas.
Terminology associated with sarcomas can be baffling and often hard to pronounce! Therefore, patient friendly information, explaining these terms in easy to understand language is available from specialist sarcoma MDTs (usually the nurse specialist).
The measures aim to ensure speedy and efficient initial referral from primary care, or another hospital doctor, to the sarcoma MDT who then arrange for further tests in designated diagnostic clinics. Biopsies for patients with suspected bone cancer should always be carried out by the bone sarcoma MDT. Patients with suspected bone cancer may be referred to a regional specialist centre in another part of the country if there is no service in their area.
The MDT should comprise members who have the skills and expertise to provide a comprehensive service from referral through to treatment and follow up. There is a need to work in partnership with staff in the designated diagnostic clinics, the rehabilitation service and with other tumour specific MDTs e.g. breast and lung, to make sure care is well coordinated, consistent and timely.
Skin cancer includes basal cell cancer (also called rodent ulcer) and squamous cell cancer, which together are known as non-melanoma skin cancer. The other main type of skin cancer is malignant melanoma. Non-melanoma skin cancer is one of the most common types of cancer in the world, affecting slightly more men than women. There are an estimated 100,000 new cases of non-melanoma skin cancer every year in the UK.
Melanoma is relatively rare, but is becoming more common, with currently almost 13,000 new cases diagnosed each year in the UK. It is most common in people aged 15-34.
The measures identify six levels of care, differing in the degree of specialisation ranging from GPs through to super specialist MDTs. The decision regarding who will treat depends on the cancer type, size, position on the body and the complexity of the procedure.
Skin cancer service delivery arrangements are complex, therefore, close working relationships between primary and acute care, including pathology, are essential to ensure all specimens are sent for analysis, referral, if necessary is speedy and treating clinicians only practice within predetermined parameters.
Given the nature of skin cancer surgery, it is important to involve plastic surgeons in discussions about treatment options/methods.
Upper GI Measures
A group of cancers are classified under the label ‘upper gastro-intestinal’; they are stomach, oesophagus, pancreas, liver and gall bladder.
Stomach cancer is a relatively uncommon cancer with around 6,000 new cases diagnosed each year. Men are twice as likely to be affected then women and it is primarily a disease of aging. Oesophageal cancer is uncommon, but not rare, as it is the ninth most common type of cancer in the UK, with more than 8,000 new cases diagnosed each year. It mainly affects people over the age of 55, with the average age at diagnosis being 72. The condition is more common in men than in women.
Pancreatic cancer is when a tumour starts to develop in the pancreas and can occur at any age, but tends to affect people aged between 50 and 80; it is rare among younger people. Around 8,000 people are diagnosed with pancreatic cancer each year, of which approximately 63% of people are over 70 and men tend to be more affected than women.
Liver Cancer is either primary, arising in the liver, which is relatively rare, or secondary where it has spread from another part of the body; this is more common. It is more common in men and occurs mostly in people with cirrhosis of the liver. Cholangiocarcinoma occurs in the lining of the bile ducts. It is a rare cancer, with around 1,000 new cases each year in the UK and is more common in women. Cancer of the gall bladder is rare with around 670 new cases in the UK each year. It’s very rare in people under 50 and is most often seen in people over the age of 70; it is more common in women.
UGI cancer measures identify three levels of service delivery, comprising diagnostic teams, diagnostic/local MDTs and specialist MDTs. The latter can be either a team specialising in oesophagus and stomach cancer only, or incorporate liver and pancreas. Alternatively, some networks may agree to a stand-alone specialist pancreas MDT and/or a stand-alone liver resection MDT. It is important for these teams to work closely together, and with other tumour MDTs, to ensure patients receive the right care/treatment that is consistent, well-coordinated and undertaken by the right team, in the right place, without delays.
The measures outline what each of the above services is responsible for, including the scope for treatment of patients outside the specialist MDTs. This includes acceptable options for the care pathway of patients with UGI cancers managed by local UGI MDTs. The local teams are mainly responsible for palliative care/treatments often used to relieve a blockage or palliative chemotherapy to try and shrink the tumour. However, it is essential that all patients are individually discussed with a member of the specialist team prior to commencement of such proposed treatment.
Urological cancers occur in the bladder, prostate gland, kidneys, testes and penis. Bladder cancer is described as superficial or non-muscle invasive if the cells are contained inside the lining of the bladder; this is the most common type of bladder cancer, accounting for 7 out of 10 cases, and the least serious.
Prostate cancer is the most common cancer in men aged 70 plus and accounts for 25% of all newly diagnosed cases. Kidney cancer comprises a number of different types of cancer, the most common type is known as renal cell carcinoma, which accounts for more than 80% of all kidney cancers.
Penile cancer is a rare type of cancer that occurs in the skin or tissues of the penis. There are less than 550 new cases each year in the UK and it is most often diagnosed in men over 50. Testicular cancers are classified by the type of cells the cancer first begins in; the most common being ‘germ cell testicular cancer’, which accounts for around 95% of all cases.
The measures identify different levels of care; local, specialist and supranetwork, each with their own MDT. There are criteria specifying what each team is responsible for regarding their scope of practice for urological cancers. For example, patients with testicular/penile cancer should be referred to a supranetwork team; major surgery for patients with bladder/prostate cancer should be undertaken by the specialist MDTs. The scope of practice of local teams is also clearly specified.
The different MDTs above are required to work closely together to ensure care/treatment is consistent, well-coordinated and undertaken by the right team, in the right place and without delays in the care pathway.
Peer Review also covers the following cancer services, however these reports are not available on the My Cancer Treatment mapping functionality, however reports for most services can be obtained from the team please contact us at firstname.lastname@example.org
Acute Oncology Measures
Several national reports recommended that a more systematic approach is needed to deal with cancer-related emergencies, to ensure speedy referral to cancer specialists. These recommendations have been gathered under the umbrella of the ‘Acute Oncology Service’. Most hospitals now have a team in place that covers all relevant services, tumour types and treatment methods, and for this reason acute oncology is now reviewed as a separate activity.
The range of patients includes patients potentially suffering from acute complications of cancer treatments and those suffering from certain emergencies caused by the disease process itself.
The measures also apply to some specific arrangements for one particular aspect of acute oncology called metastatic spinal cord compression (MSCC). This is a very acute emergency that needs urgent assessment and requires radiologists, neurosurgeons and oncologists to work together to decide on the best and most appropriate treatment for each patient.
Cancer of Unknown Primary (CUP) / Malignancy of Unknown Origin (MUO) Measures
Each year in the UK over 10,000 people are diagnosed with CUP, which is around 3.4% of all cancer diagnoses. It is more common in older people, but may affect those in their 40s and 50s.
Some patients present to hospital with cancer that has already spread (metastatic) but when investigations are undertaken, doctors can’t tell which part of the body the cancer started in (the primary cancer site). Patients with CUP often suffer problems and delays with their diagnosis and management, compared to patients where the primary site is obvious or highly probable at presentation.
The cancer peer review measures have been developed to speed up the process and eliminate some of the delays so that discussions around treatment do not have to wait for a definite primary diagnosis. If during further testing a primary cancer site is identified, then patients are referred on to the appropriate tumour specific MDT e.g. breast, lung.
The CUP MDT should comprise members who have the skills and expertise to provide a comprehensive service, with detailed arrangements for on-going support for patients/carers throughout the pathway of care. This could include referral to palliative care to help patients cope with the symptoms of cancer or a referral for psychological support. The team will work closely with the Acute Oncology Service team as many of these patients will present as emergency admissions.
It is encouraging to know that recent advances in diagnostic techniques have improved to enable clinicians to find the primary sites, even when the original diagnoses are CUP. Such knowledge helps to determine the best treatment for patients.
Children’s measures describe the structures and processes that help to ensure children are cared for in an age appropriate environment. They also determine the resources needed to ensure the right care/treatment is delivered in the right place, at the right time by staff with the right expertise. Close working relationships with network groups, designated children’s centres, local trusts and primary care are essential to enable these ideals to become a reality.
Specialist Palliative Care Measures
There are doctors, nurses and allied health professionals throughout the country who specialise in palliative or supportive care. They are based in hospitals, hospices, specialist palliative care units, pain clinics and the community. Palliative care specialists make sure patients’ symptoms are well controlled and that help and support is available throughout the care pathway as necessary.
The measures focus on specialist palliative care MDTs who work to network guidelines to ensure palliative care is well coordinated, consistent and, most importantly, available as and when patients need treatment and support for symptom control. Close working relationships with tumour specific MDTs e.g. lung, breast and community services is essential for speedy referral to expert advice regarding optimal treatment.
Teenagers and Young Adults Measures
Teenagers and Young Adults measures describe the structures and processes that help to ensure they are cared for in an age appropriate environment, with the right support systems. The measures also determine the resources needed for the right care/treatment to be delivered in the right place, at the right time by staff with the right expertise. Close working relationships with network groups, designated TYA principle treatment centres, acute trusts and primary care are essential to enable these ideals to become a reality.