Public Health England
The report shows that age, general wellbeing and other factors can affect 30-day mortality following chemotherapy for breast and lung cancer.
The data gives new insights about the real-world chemotherapy treatment of patients in the NHS in England which was previously only available from clinical trials. In 2014 alone, the dataset included over 2 million records for over 160,000 different patients.
The study looked at all women with breast cancer (23,228 patients) and all patients with the most common form of lung cancer (9,634 patients) treated with chemotherapy in England in 2014. It examined how many of these patients died within 30 days of the start of their most recent chemotherapy.
The paper 30-day mortality after systemic anticancer treatment for breast and lung cancer in England: a population-based, observational study is co-authored by PHEs National Cancer Registration and Analysis Service and Cancer Research UK.
Most of the people who died within 30 days were receiving palliative treatment (where the cancer cannot be cured and chemotherapy is given to relieve symptoms and improve quality of life): 569 breast cancer patients and 720 lung cancer patients.
There were also a small number of deaths in those patients given treatment with the intention to cure: 41 breast cancer patients and 53 lung cancer patients.
There were no clusters of these deaths. The majority of hospitals had no curative intent deaths at all; those deaths were scattered across 53 different Trusts (just under half of the total).
Older patients with more advanced disease, who also had other illnesses and a worse performance status, were more likely to die.
Patients with a high body mass index (BMI) were less likely to die than those with a low BMI.
Patients were most likely to die when being given their first round of chemotherapy.
Early death rates from clinical trials in the treatment of non-small cell lung cancer with curative intent are around 0.8%. The study found a death rate of nearer 3% across the NHS.
The study found 7 hospitals treating breast cancer and 5 treating lung cancer with an intention to cure where the risk-adjusted death rates (taking into account the new rich data on every patient treated) were outside the confidence limits expected.
Dr Jem Rashbass, Cancer Lead for PHE, said:
We are privileged in England to have access to such high quality cancer data. This world-leading database will allow us to monitor the quality of chemotherapy treatment given to all patients across the NHS in near real-time.
Chemotherapy is a vital part of cancer treatment and is a large reason behind the improved survival rates over last 4 decades. However, it is powerful medication with significant side effects and often getting the balance right on which patients to treat aggressively can be hard. Studies like this help improve our understanding of how people are affected by chemotherapy in the real world and most importantly help us to treat patients better.
Those hospitals whose death rates are outside the expected range have had the findings shared with them and we have asked them to review their practice and data.
Lead clinical author Professor David Dodwell, Institute of Oncology, St James Hospital, Leeds said:
This is the first time that 30-day mortality following chemotherapy has been investigated on a national level. Age, general wellbeing, and whether patients are treated with palliative or curative intent are all factors that affect the risk of early mortality of breast and lung cancer patients. The factors we have identified should be a focus of discussions about treatment between patients and their clinicians to allow better informed decisions. The SACT data and other data sources in NCRAS are a critically important resource for future research.
Professor Peter Johnson, Cancer Research UKs Chief Clinician, said:
This is the first time this type of data has been collected and analysed so extensively. This was a huge undertaking but it now means we have a way to measure if the health service is getting better at delivering the right drugs to the right patients. Its vital that this data continues to be collected and analysed routinely so that we can make sure it is continually improving.
- The Lancet Oncology paper 30-day mortality after systemic anticancer treatment for breast and lung cancer in England is a population-based, observational study.
- Trust level findings are detailed in the companion report, published today (Wednesday 31 August 2016) by NCRAS: Trust-level 30-day mortality after systemic anticancer treatment for breast and lung cancer in England companion report.
- A more detailed narrative on the findings and the database is available in a blog by Dr Jem Rashbass.
- Chemotherapy is an important part of treatment for many people with cancer.
- In the 1970s, 4 in 10 women diagnosed with breast cancer in England and Wales survived their disease beyond 10 years; now its around 8 in 10.
- In the 1970s, 5 in 100 people diagnosed with lung cancer in England and Wales survived their disease beyond 5 years; now its around 8 in 100.
- The SACT database and the analyses presented in the Lancet Oncology paper and complementary report are produced by PHEs National Cancer Registration and Analysis Service.
- Public Health England exists to protect and improve the nations health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.