Audit sets out ways to improve care for patients with head and neck cancer

The treatment and care of cancer patients could be improved if more were done to improve record keeping according to a report out today from The Information Centre for health and social care.

· Quality data supports services
· More training and direction required, says report

The treatment and care of cancer patients could be improved if more were done to improve record keeping according to a report out today from The Information Centre for health and social care.

Care for one quarter of patients with throat and mouth cancer is not recorded at multi-disciplinary team meetings, according to the report. As care for this group of patients is complex and involves many specialists, this may result in inappropriate treatment decisions for some patients.

The second analysis of head and neck cancer – also identifies a variance in the completeness of records between different organisations and between individual records.

Some important aspects of caring for patients, such as dental assessment, speech and language therapy, dietetics and palliative care could not be assessed through the audit owing to an absence of data.

And the report from DAHNO - Data for Head and Neck Oncology - recommends that NHS Provider Trusts and Cancer Networks should facilitate data collection through multi-disciplinary teams by providing resources, training and direction.

Cancers of the mouth and throat are associated with heavy smoking and drinking and affect mainly older people, 90 per cent over the age of 50. Such cancers have a significant impact on functions such as eating, drinking, speech, swallowing and normal social interaction. Patients require intensive investigation, multiple treatments and prolonged rehabilitation with long-term support to achieve an adequate recovery.

Richard Wight, Consultant Head and Neck Surgeon, and head and neck audit lead, said: “The second annual report confirms the continuing commitment and enthusiasm of head and neck professionals to demonstrate the quality of the complex care they provide. The audit provides valuable information that will help clinicians improve care and assure patients through high quality, evidence-based information.

“We are now in a position to target gaps in provision, locally or nationally, and direct research to the real problem areas. In this way we aim to improve the long-term survival rate in head and neck cancer independent of advances in therapy.”

In all, data were submitted concerning some 745 cases of larynx cancer and 698 cases of oral cavity cancer.

Key findings from the audit include:
· Delays in diagnostic imaging have been reduced
· There are early indications that voice box cancer is more common amongst people who live in deprived areas and diagnosed later
· Around one in five of all referrals - 21 per cent - for cancer of the mouth are made by dentists and community dental services, demonstrating the importance of general dental services in screening for oral cavity cancer.
· Head and neck cancer patients may have difficulties in accessing radiotherapy services, which may produce delays to treatment. In future more comprehensive capture of radiotherapy data will help to clarify this.
· Overall, head and neck surgery - despite being complex – appears to be a safe procedure with few pre and post-operative deaths recorded based on the information submitted.

Professor Mike Richards, National Cancer Director, said: “National clinical audits have the potential to synthesise information on the quality of care delivered to all patients with a particular condition across the country.

“I commend the hard work done by everyone who has contributed to this second report on the DAHNO audit.”

Dr Jonathan Boyce, Head of Audit at the Healthcare Commission, said: "These audits will help to identify which local services have most need to improve, then assess whether they have succeeded. It is essential that all Trusts carry out the audits properly, and we will encourage them by using their participation and data completeness as part of trusts’ annual health check assessments in 2006/07."

See full report:
http://www.icservices.nhs.uk/ncasp/pages/audit_topics/DAHNO/annualreport05-06.asp

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