COVID-19 rapid cancer registration and treatment data

Introduction

Rapid cancer registration and associated clinical activity data is being made available for the COVID-19 period to support the public health response by NHS Digital (NHSD) and other agencies, and service reorganisation by the NHS.

The data is based on a rapid processing of cancer registration data sources, in particular on Cancer Outcomes and Services Dataset (COSD) information. Full, gold standard cancer registration data is not yet available for much of this time period as it relies on additional data sources, enhanced follow-up with trusts and expert processing by cancer registration officers. This rapid dataset provides a quicker, indicative source of cancer data.

This tool provides a suite of metrics relating to cancer incidence and treatment data, derived from this rapid registration data. It is hoped these metrics will support clinicians, trusts, and cancer alliances in planning and providing cancer services.

Please read the Uses and Limitations page for details of how this can be used and how it compares to full cancer registration data.


Data timeliness

The most recent update, released on 27 January 2022, is based on the data available by 1 January 2022. Data is estimated to be near-complete for:

  • Diagnoses up to the end of September 2021, although with slightly lower completeness from April 2021 onwards.
  • Surgical tumour resections received up to the end of March 2021
  • Chemotherapy received up to the end of August 2021
  • Radiotherapy received up to the end of October 2021

It is therefore important to note that the data is not 100% complete, particularly for diagnoses and treatments in more recent months.

The next update is planned for 3 March 2022. If, for some reason, it is not possible to release on this date, it will be updated as soon as possible after this.


Useful information on the data included

Patients - the tool includes all patients diagnosed or treated in England from all age groups.


Data period - the tool covers new diagnoses and their treatment, and also all surgical tumour resection activity for the period 1 January 2018 onwards.


Update frequency - the tool will be updated regularly to include the latest data on diagnosis, surgical tumour resection activity and treatment proportions. This may include updates to earlier months as the underlying data is updated regularly.


Incidence data - the tool includes rapid cancer registration data on the number of new cancer diagnoses of malignant cancer excluding non-melanoma skin cancer (ICD10 C00-C97, excluding C44), by date of diagnosis.


Early stage proportion - the tool includes the proportion of staged cancers diagnosed at stage 1 or 2, from the rapid cancer registration data, by date of diagnosis.


Treatment proportions - the tool includes the proportion of patients in the rapid cancer incidence data who are recorded as having received treatment for their tumour, for each of chemotherapy, radiotherapy and surgical tumour resections, by date of diagnosis.


Surgical tumour resection activity - the tool separately includes the total number of surgical tumour resection procedures undertaken by date of activity, as a broader measure of surgical activity.


Cancer groups - these are defined by ICD10 codes as below:

For chemotherapy proportion, radiotherapy proportion and treatment combinations, an 'Other malignant neoplasms' group is presented, comprising the Endocrine, Bone and soft tissue and Unknown cancer groups.


Demographic factors - data is available with breakdowns by demographic factors, namely:

  • Age - age group at diagnosis (<50, 50-59, 60-69, 70-79, 80+)
  • Sex
  • Socio-economic deprivation - deprivation quintile from the English indices of deprivation 2019 , based on area of residence at diagnosis (from 1 - most deprived to 5 - least deprived)
  • Ethnicity - broad ethnicity groups (Asian, Black, Mixed and Other, Unknown, White)
  • Route to Diagnosis - Derived Route to Diagnosis based on available data (Grouped into Emergency presentation, GP referral, Screening, TWW, Other outpatient and Other [combining Inpatient elective, Death Certificate Only (DCO) and Unknown routes]; not available for surgical tumour resection activity)
  • Stage at diagnosis - TNM stage at diagnosis (only available for some cancer groups and/or for some of the cases within each cancer group, as detailed above; not available for surgical tumour resection activity)

Cancer Alliance is based on patient's postcode at diagnosis for incidence and treatment proportions data. For surgical tumour resection activity, cancer alliance is based on the provider recorded for the procedure.



Using the tool
Pages

There are seven pages at the top of the dashboard: Introduction; Uses and Limitations; Summary; Update log; Demographic factors; Time to treatment - Demographics and Geography.

Introduction and Uses and Limitations provide summary information about the dashboard and data used, and the Summary page provides key results and patterns for England-level data. The Update log page provides a summary for each release of any data updates included or any other changes to the tool. The charts and data are shown on the remaining pages:

  • Demographic factors: This page provides, for all cancers or by cancer group, England-level data broken down by choice of demographic factors: total, age, sex, deprivation, ethnicity, Route to Diagnosis and stage at diagnosis.
  • Time to treatment - Demographics: This page provides, for all cancers or by cancer group, England-level treatment proportion data by time to treatment and a choice of demographic factors.
  • Geography: This page provides overall data for England or by cancer alliance, for all cancers or by cancer group.


Filters

On each page there are a number of filters in the left-hand sidebar. These include a selection of cancer groups for all pages and choices of demographic factors or geography, as relevant. Adjusting these filters will change all the data on the page

On the 'Demographic factors' and 'Time to treatment - Demographics' pages, only one factor can be selected at a time.

On the 'Geography' page, only one cancer group and one geography can be selected at a time.


Charts and data

The three pages have a number of tabs presenting the data in different ways.

The 'Demographic factors' and 'Geography' pages present time trend and annual comparison data:

  • Time trend (chart) - Charts of the trends over time, with separate lines for each demographic factor (Demographic factors page) or cancer group (Geography page)
  • Time trend (table) - Data table for the trends over time
  • Annual comparison (chart) - Charts comparing the data to the same month in the previous year, showing the percentage of usual activity for incidence and tumour resection activity and the difference from usual activity for early stage proportion and treatment proportions
  • Annual comparison (table) - Data table comparing the data to the same month in the previous year

The 'Time to treatment - Demographics' and 'Geography' pages provide time to treatment data:

  • Proportion of cases - For treatment proportions data, charts showing trends over time split by time to treatment
  • Proportion of treatment - For treatment proportions data, charts showing, over time, the proportional distribution of time to treatment

The 'Demographic factors' page additionally includes tabs presenting the breakdown by demographic factors as a proportion of all activity, for the incidence and surgical tumour resection activity metrics only:

  • Time trend (factor proportions) - Charts of the trends over time showing the proportion of cases for each level of demographic factors
  • Annual comparison (factor proportions) - Charts comparing, for a given month, the proportion of cases by each level of demographic factors compared to the same month in the previous year

The 'Geography' page additionally includes tabs presenting treatment combinations data:

  • Treatment combinations (chart) - Charts of the trends over time in the proportion of patients receiving surgical tumour resection, chemotherapy and radiotherapy, independently and for all combinations
  • Treatment combinations (table) - Data table for the trend over time in the treatment combination proportions


Exploring the charts

To explore the charts in more detail, consider the following tips:

  • For information about the data points, hover over the points on the chart
  • Zoom in or out of the chart: Click the plus or minus symbols at the top right-hand side or draw a box within the chart to zoom in on that area
  • Move around the chart: Click on the cross ('Pan') symbol at the top right-hand side
  • Reset the chart: Click on the house symbol at the top right-hand side
  • Focus on specific breakdowns within the chart, by
    • Removing a line or bar: Click on the item in the legend
    • Isolating a single line or bar: Double click on the item within the chart
    • Click on the item again to remove these selections
  • Save the plot as a PNG file: Click on the camera symbol at the top right-hand side


Acknowledgement

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS Digital (NHSD).


Feedback

We intend this tool to be as useful as possible to the community and aim to improve them to meet user needs. Please send any feedback to NCRASenquiries@phe.gov.uk

This email address can be used for general enquiries to NDRS, please do not include sensitive or patient identifiable information.

Uses

The rapid cancer registration dataset, including summary data available here, may be useful for service improvement projects including healthcare planning and prioritisation. However, it is poorly suited for epidemiological research due to limitations in the data quality and completeness (please see the rapid cancer registration dataset data quality document for details).

The data could be used to aid the planning of cancer services in recovering from the initial impact of COVID-19 and also in trying to minimise the continued impact. It provides teams with the ability to gauge practice changes happening nationally and locally. It may also help to highlight areas of particular concern, to direct future service or research activities.

This data is not suitable for making straightforward 'like for like' comparisons between cancer alliances and should not be used as a performance metric to compare activity between areas. In addition to the numerous clinical factors which typically inform a treatment decision, data for individual cancer alliances will be affected by a range of other factors at this time, including:

  • local arrangements for changing cancer services during this time (eg. introduction of cancer hubs in some areas, use of private hospitals),
  • impact of COVID-19 for their trust, including number of cases admitted within their trust and staffing shortages,
  • the patient's socio-demographic characteristics and risk from COVID-19.

However, this data can be used by cancer alliances, in conjunction with local knowledge, to understand the impact COVID-19 had on their services, to monitor recovery from the impact and to highlight areas where further, targeted service improvement measures may be beneficial.


Data collection and data quality

Hospital trusts submit the data used to create the rapid cancer registration dataset (RCRD), and these collections may have been affected during the COVID-19 time period due to pressures on local systems. Data for RCRD is continually submitted and updated by trusts, and therefore the number of diagnoses from the rapid cancer registration dataset is subject to change in future updates, as more data becomes available. This is most likely to affect the later months included in each release. Data completeness for more recent months will also be affected by the differing completeness of the datasets used to derive cases in the RCRD data, largely the Cancer Outcomes and Services Data (COSD), with a smaller proportion of cases derived from the Cancer Waiting Times (CWT) or Hospital Episodes Statistics (HES) datasets. Detailed assessments of the data quality of the RCRD are available separately.

Recent treatment proportions data published here will often be lower than previous months. This data is based on diagnosis date and the time between diagnosis and treatment means they will not have complete follow-up in the available data; some treatments may not yet have occurred or been recorded. However, some information is included broken down by time to treatment which will allow better comparability for recent months with only partial follow-up.

Data with incomplete follow-up is denoted in figures by dashed lines or a reduced intensity of colouring and in tables by an asterisk. The data is determined as complete or incomplete based on the latest near-complete month for the relevant treatment dataset(s) (see the Data timeliness section on the Introduction page) and the agreed treatment interval for the cancer group (see the Treatment definitions and proportions section below).

For ethnicity, stage at diagnosis and Route to Diagnosis breakdowns, data completeness is generally lower for recent months than for earlier months in the time series. This reflects the current availability of the data for these breakdowns. Due to these data quality issues and to avoid providing potentially misleading data, Routes to Diagnosis data is not provided for the latest couple of months. For a given month, the completeness of these breakdowns is likely to increase over time, with updates to the dashboard, as more data becomes available. Recent work has shown that this is particularly true for the stage at diagnosis data, with completeness increasing by around 10 to 15% from first publication to more stable data around 4 to 6 months later.


Clinical notes for interpretation

The data presented in this tool, particularly during recent months, is likely to be affected by many clinical factors. These include, but are not limited to, the following:

  • Cancer incidence data may be affected by additional pressures on endoscopy or imaging capacity due to increased use related to COVID-19 or reduced overall capacity resulting from additional infection control measures, for example particularly due to the potential aerosol generation from endoscopy procedures [1, 2]
  • The number of new diagnoses will be affected by changes in patient behaviour, with fewer people thought to be reporting possible cancer symptoms. Decreases were seen during the main lockdown period in the numbers of GP appointments [3] and of people urgently referred for suspected cancer [4]. With people encouraged to continue reporting worrying symptoms to their doctor and doctors encouraged to refer patients as usual [5], the number of referrals increased over subsequent periods although remaining lower than usual for several months [6].
  • For breast, colorectal and cervical (within the gynaecological grouping) cancers, data on new cancer diagnoses will be affected by a reduction in screening activity, particularly during the initial peak of the COVID-19 pandemic and with the return to normal levels taking a varying amount of time.
  • National guidelines were published to inform the provision of systemic anticancer [7] and radiotherapy treatments [8] during the COVID-19 pandemic, on the basis of evidence available at the time, to protect patients and staff from COVID-19 infection or risk and to manage capacity.
  • National guidance provided advice on the prioritisation of surgical procedures for a range of disease areas, including cancer procedures, with possible timescales relating to the prioritisation [9].
  • A variety of cancer group or specialism related guidelines [10, 11] were produced to recommend ways of working, priorities or alternative treatment plans during the COVID-19 pandemic, for example to delay high-risk surgical procedures and increase neoadjuvant treatment.
  • Cancer alliances and providers were encouraged to introduce COVID-free cancer hubs and use independent sector facilities which had been secured for NHS use [12, 13, 14]. The cancer hubs were sites where patients from a wider geographical area could be treated for cancer in a separate environment, away from COVID-19 related activity. Both cancer hubs and the use of private facilities were intended to ensure cancer treatment continued with a reduced risk of COVID-19 infection. However, how and when these measures were implemented differed between areas which may have resulted in some delays to treatment and may particularly contribute to differences between some of the cancer alliance results presented here.
  • There has also been an increase in the provision of chemotherapy in home settings [15]. Such treatments might not be fully captured in the data used, due to some e-prescribing systems submitting data at the point of administration rather than prescription. This could contribute to apparent decreases in chemotherapy activity.
  • Possible increases in hormonal therapy treatments can be detected from the Cancer Waiting Times data from March 2020, but this data is not reported here because this source is known to under-report the volume of hormonal therapy treatments in comparison to primary care prescribing data. Such changes in hormonal therapy treatments may have affected which other treatments patients received for Prostate, Breast or Gynaecological cancers, or when they received these treatments.


Comparison to full, gold standard cancer registration data

The rapid cancer registration dataset is a new and developing dataset. It is derived from routine data sources, without manual input from expert cancer registration officers. It relies heavily on the quality and completeness of submitted data, without information being cross-checked or additional data sources being followed-up. It is therefore not as complete as full, gold standard cancer registration data and has not been quality assured to the same degree.

Comparison of rapid cancer registrations data to full cancer registration data for April-September 2018 has shown that:

  • 13.4% of gold standard cancer registrations were not identified using the rapid cancer registration process (missed registrations)
  • 5.3% of cases identified in the rapid cancer registration dataset cannot be linked to a gold standard cancer registration (incorrect rapid registrations, false positive error)

These error rates vary between cancer groups, with lower rates of missed registrations or incorrect rapid registrations for sites such as breast and prostate, but higher error rates for bone and soft tissue and unknown tumours. It is known that these tumours can be more difficult to diagnose than others, often requiring additional investigations or tests; this may mean that it takes longer for full diagnosis details to be received in routine data sources. Final gold standard cancer registration numbers are likely to change more for these cancer groups than for others. Particular caution is therefore advised when using data in this tool for these cancer groups and the data quality should be carefully considered to determine whether it is suitable for the purpose of the work.

For bladder cancer, comparison to gold-standard data indicates that individual diagnoses identified as malignant (C67) in RCRD correspond to a mixture of malignant and in-situ (D09) diagnoses in the gold-standard data. However, there are also gold-standard malignant bladder cancer cases which are identified as non-malignant in RCRD and so not included in numbers within this tool. The opposing impact of these differences largely cancel each other out, meaning that the overall number of malignant bladder cancer diagnoses identified from RCRD corresponds well to the gold-standard data. However, caution is advised when considering detailed demographic and geographic breakdowns of the bladder cancer data, as there may be additional differences between RCRD and the gold-standard data in the characteristics for malignant and non-malignant bladder cancers.

Treatment proportion data will be lower than similar proportions published based on full cancer registration data. The rapid treatment data presented here is based on surgery recorded in COSD or inpatient HES data, chemotherapy recorded in SACT data and radiotherapy recorded in RTDS data. The standard methodology used elsewhere additionally uses information from the cancer registration recorded AT_TREATMENT_ENGLAND data. This data includes treatment information from a range of other sources which has been recorded and linked to a diagnosis by cancer registration officers. A review of the data sources used for existing treatment proportions information indicates that the AT_TREATMENT_ENGLAND data alone provides about 12% of surgery data, 19% of chemotherapy data and 7% of radiotherapy data.


Comparison to Cancer Waiting Times first treatments data

Although the rapid cancer registration data is not as complete or detailed as gold standard cancer registration data, it is more comparable to the gold standard cancer registration data than another commonly used proxy dataset, Cancer Waiting Times (CWT) first treatments data. For example:

  • RCRD better identifies new cancer diagnoses over time as it is based on a cancer diagnosis date rather than date of first treatment, which on average is around 1 month after diagnosis but with considerable variation by cancer group and treatment modality.

  • Although RCRD doesn't capture all new cancer cases, it appears to correctly identify more cases than the CWT data which is known to include about 80% of full cancer registration cases.

  • RCRD more readily includes a range of additional information, for example, demographics, cancer stage at diagnosis and Route to Diagnosis, and is linked to detailed activity data.

When comparing these different datasets, care should also be taken to ensure the cancers included are comparable. For example, many analyses of CWT first treatments data include some non-melanoma skin cancers (ICD-10 C44) and in-situ breast cancers (D05), which are often excluded from cancer statistics.


Presented data

Data is presented in two main ways:

  • as a time trend showing activity or treatment proportion data by month
  • as an annual comparison, comparing data for a given month to data for the same month in a previous year (usually the preceding year is used for this comparison but for March 2021 onwards, data is compared to the same month in 2019 to avoid comparison to pandemic-affected months in 2020)

The monthly incidence and surgical tumour resection activity data are mainly presented as working day adjusted counts. These are adjusted for the number of working days in each month and presented for an average month with 21 working days. This provides better comparability of monthly data to avoid variation resulting from differences in the number of weekend days or bank holidays. This is particularly important for the comparisons to the same month in the previous year. However, the adjustment for the number of working days each month means that the adjusted data presented will differ from record-level data and will not add-up to observed counts of the data. Unadjusted (observed) counts are also provided in some tables for completeness, to provide real counts of patient activity.


Early stage proportion

Stage at diagnosis is one of the most important factors affecting cancer outcomes, and promoting earlier stage at diagnosis is one of the key aims of the NHS Long-Term plan. Measuring and monitoring national staging data is crucial to understand variation and deliver evidence-based decisions.

In line with other publications, cancers diagnosed at stage 1 or 2 are considered to be diagnosed at an early stage, as opposed to those diagnosed at stage 3 or 4. Only cancers with a known staging value are included in the denominator of this proportion; this is known as a complete case approach.

The early stage proportion results presented here are not case-mix adjusted and do not account for differences between populations. The case-mix of cancers diagnosed impacts on the percentage of early stage cancers. For example, breast cancer is far more likely to be diagnosed at stage 1 and 2 than lung cancer. Therefore, cancer alliances with a higher than average occurrence of breast cancer tend to have a higher percentage of early stage cancers compared to alliances with a higher than average occurrence of lung cancer.


Treatment definitions and proportions

A tumour resection is an attempt to surgically remove the whole of the primary tumour. These have been identified using lists of OPCS-4 procedure codes which were agreed through consultation with site-specific clinicians. These lists of procedure codes are detailed in CAS-SOP #4.5 Linking treatment tables - chemotherapy, tumour resections and radiotherapy , with the exception of melanoma for which a list has only recently been defined; this can be provided on request.

Surgical tumour resection procedures have not been defined for all cancer groups and are therefore only reported for cancer groups with defined lists, as above. Some tumours of other cancer groups could also have been treated with surgery.

For some cancer groups, some procedures (for example, endoscopic resections) may be appropriate for early stage disease only. However, as stage data is currently less complete in the rapid cancer registration data, this tool only includes data on surgical tumour resection procedures appropriate for all stages of diagnoses; this means the number of surgical tumour resection procedures and the surgical tumour resection proportions for some cancer groups may be lower than expected and lower than published elsewhere (for example, in treatment data based on full, gold standard cancer registration data ).

Radiotherapy includes both curative and palliative teletherapy procedures; brachytherapy procedures (including molecular radiotherapy) are excluded.

Chemotherapy includes both curative and palliative chemotherapy, but excludes hormonal therapy and other supportive drugs such as zoledronic acid, pamidronate, and denosumab.

The tumours in the 'Other Care' category may have received treatment other than chemotherapy, radiotherapy and surgical tumour resection, such as hormonal therapy or management of symptoms; received treatment outside of the time frame assessed; received treatment in a private capacity (ie. treated in a private setting which was not NHS commissioned); or there may be data missing from the datasets used.

The data on treatments proportions includes data on treatments occurring in the period from 1 month before diagnosis to either 6, 9, 12, 15 or 18 months after diagnosis. The time period within which the majority of first course of treatments occurred varies by cancer group and treatment type. Therefore, an appropriate time period for each cancer group has been chosen using a data-driven approach in consultation with clinicians.

The treatment proportion data published here is based on the methodology and treatment intervals detailed in CAS-SOP #4.5 Linking treatment tables - chemotherapy, tumour resections and radiotherapy , applied to the rapid cancer registration data cohort and using only COSD surgery, HES, SACT and RTDS data to identify treatment.

The surgical tumour resection activity data is based on the date of the surgical procedure. Many of the patients receiving surgery will have been diagnosed several months prior to this surgery. Some patients may also be included more than once, where they had one/more of the included surgical procedures on more than one occasion.


Data sources

  • The rapid cancer registration and treatment data is derived analytically from the data submitted for the following datasets:
  • Cancer Outcomes and Services Data (COSD)
  • Systemic Anti-Cancer Therapy data (SACT)
  • Radiotherapy Dataset (RTDS)
  • Hospital Episodes Statistics (HES) data
  • Cancer Waiting Times (CWT) data


Related information


References

[1] Clinical guide for the management of patients requiring endoscopy during the coronavirus pandemic. NHS England and NHS Improvement, 2 April 2020. Now available from www.cmcanceralliance.nhs.uk/download_file/view/934/344

[2] Clinical guide for triaging patients with lower gastrointestinal symptoms. NHS England and NHS Improvement, 16 June 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0551-triaging-patients-with-lower-gi-symptoms-16-june.pdf

[3] Appointments in General Practice - April 2020. NHS Digital, 28 May 2020. https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/april-2020

[4] Mahase E. Covid-19: Urgent cancer referrals fall by 60%, showing brutal impact of pandemic. BMJ 12 June 2020; 369; doi: https://doi.org/10.1136/bmj.m2386

[5] Letter regarding the 'Second phase of NHS response to COVID19 for cancer services' from Dame Cally Palmer and Professor Peter Johnson, NHS England and NHS Improvement, 8 June 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0511-second-phase-of-nhs-response-to-covid-19-for-cancer-services-letter.pdf

[6] Mahase E. Cancer treatments fall as referrals are slow to recover, show figures. BMJ 13 October 2020; 371; doi: https://doi.org/10.1136/bmj.m3958

[7] NG161: COVID-19 rapid guideline: delivery of systemic anticancer treatments. NICE, 20 March 2020 updated 27 April 2020. www.nice.org.uk/guidance/ng161

[8] NG162: COVID-19 rapid guideline: delivery of radiotherapy. NICE, 28 March 2020. www.nice.org.uk/guidance/ng162

[9] Clinical guide to surgical prioritisation during the coronavirus pandemic. Federation of Surgical Specialty Associations (FSSA) at the request of NHS England and NHS Improvement. First published 11 April 2020. Updated publication from 25 September 2020: https://fssa.org.uk/_userfiles/pages/files/covid19/prioritisation_master_250920.pdf

[10] Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer. NHS England and NHS Improvement, 23 March 2020. Now available from https://www.acpgbi.org.uk/content/uploads/2020/03/specialty-guide-acute-treatment-cancer-23-march-2020.pdf

[11] Coronavirus guidance from a variety of professional societies. See longer list below.

[12] Letter regarding 'Advice on maintaining cancer treatment during the COVID-19 response' from Dame Cally Palmer, Professor Peter Johnson and Professor Steve Powis, NHS England and NHS Improvement, 30 March 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0119-_Maintaining-cancer-services-_-letter-to-trusts.pdf

[13] Letter regarding 'Advice to local systems on maintenance of cancer treatment during COVID-19 response' from Dame Cally Palmer, Professor Peter Johnson and David Fitzgerald, NHS England and NHS Improvement, 6 April 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0094-Letter-to-Cancer-Alliances-6-April.pdf

[14] Letter regarding the 'Second phase of NHS response to COVID19' from Simon Stevens and Amanda Pritchard, 29 April 2020. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/second-phase-of-nhs-response-to-covid-19-letter-to-chief-execs-29-april-2020.pdf


Coronavirus guidance from a variety of professional societies

Multiple cancer groups: BASO ~ The Association for Cancer Surgery. BASO Guidance - Strategy for Cancer Surgery sustainability and recovery in the COVID 19 pandemic. 9 April 2020. https://baso.org.uk/media/99217/baso_guidance_for_cancer_surgery_9th_april_2020_v7.pdf ; Royal College of Surgeons for England, COVID-19 Guidance. https://www.rcseng.ac.uk/coronavirus/#guidance ; The Royal College of Radiologists, Coronavirus (COVID-19): cancer treatment documents https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/clinical-information/coronavirus-covid-19-cancer

Brain and CNS: British Neuro-Oncology Society, Treatment Pathways and Guidance. https://www.bnos.org.uk/clinical-practice/treatment-pathways-and-guidance/ ; The Society of British Neurological Surgeons, COVID-19 Guidelines. https://www.sbns.org.uk/index.php/policies-and-publications/covid/

Breast: Associate of Breast Surgery, COVID-19 resources. https://associationofbreastsurgery.org.uk/for-members/covid-19-resources

Colorectal: The Association of Coloproctology of Great Britain and Ireland, ACPGBI latest COVID-19 updates. https://www.acpgbi.org.uk/coronavirus/acpgbi-latest-covid-19-updates/

Gynaecological: British Gynaecological Cancer Society, COVID19 Resources. https://www.bgcs.org.uk/professionals/covid19-resources/

Head and neck: British Association of Head & Neck Oncologists, Clinician Area. https://www.bahno.org.uk/clinicians_area/default.aspx

Lung: British Thoracic Society, COVID-19. https://www.brit-thoracic.org.uk/covid-19/ ; Society of Cardiothoracic Surgery in Great Britain and Ireland, COVID-19. https://scts.org/covid-19/

Melanoma: British Associations of Dermatologists, Advice for Dermatology HCPs during Covid-19 pandemic. https://www.bad.org.uk/healthcare-professionals/covid-19

Upper GI, including Oesophago-gastric: British Society of Gastroenterology, COVID-19 Guidance & Advice. https://www.bsg.org.uk/covid-19-advice/ ; Association of Upper Gastrointestinal Surgery of Great Britain and Ireland, AUGIS Guidelines. https://www.augis.org/augis-guidelines/

Urological, including Prostate: The British Association of Urological Surgeons, Coronavirus & COVID-19. https://www.baus.org.uk/about/coronavirus_covid-19.aspx

All data in the tool is refreshed with each release, as more data becomes available. This is most likely to affect the later months included in each release.

Release 11: 27 January 2022

  • Chemotherapy proportions updated to August 2021.
  • Radiotherapy proportions updated to September 2021.


Release 10: 6 January 2022

  • Diagnoses updated to September 2021.
  • Chemotherapy proportions updated to July 2021.
  • In the RCRD data, some improvements have been made to the method used for estimating the number of diagnoses, with some changes to tumours excluded due to a previous tumour (breast and gynaecological cancer groups), exclusions due to differences with information on a death certificate and the addition of some death-certificate only tumours to the unknown cancer group. This affects data for all months, decreasing the estimated number of diagnoses by around 0.7% for all malignant cancers, excluding non-melanoma skin cancer (NMSC), for months with more stable data. This corresponds to decreases of around 2-7% for the breast, gynaecological, upper GI excluding OG, brain and CNS, and bone and soft-tissue cancer groups; and an increase of around 30% for the unknown cancer group.
  • The Route to Diagnosis grouping has changed to present Other outpatient separately to the Other group. Other now combines Inpatient elective, Death Certificate Only (DCO) and Unknown routes.


Release 9: 2 December 2021

  • Diagnoses updated to August 2021.
  • Chemotherapy proportions updated to June 2021.
  • In the RCRD data, an improvement has been made to the method used for estimating the number of breast and gynaecological cancer diagnoses, with fewer cases excluded due to previous tumour. This affects data for all months, increasing the estimated number of diagnoses by around 2% for all malignant cancers, excluding non-melanoma skin cancer (NMSC), for months with more stable data. This corresponds to increases of around 11% breast cancers and around 7% for the gynaecological cancers.


Release 8: 27 October 2021

  • Diagnoses updated to July 2021.
  • Surgery activity, surgery proportions and Routes to Diagnosis breakdown updated to March 2021.
  • Chemotherapy proportions updated to April 2021.
  • In the RCRD data, an improvement has been made to the method used for estimating the number of cancer diagnoses, to use a combination of COSD, CWT and now HES data. This affects data for all months, increasing the estimated number of diagnoses by around 2.2% for months with more stable data. Proportionally, the cancer groups with the largest changes in the number of diagnoses were brain and CNS (around 9.8% increases), upper GI excluding OG (around 9.0% increases), haematological (around 4.7% increases) and unknown (around 8.7% decreases). Where COSD and/or CWT data is more up to date than the HES data, counts will not include cases only sourced from HES, resulting in a potential for a small undercount in the most recent months.
  • Data has additionally been provided separately for some more detailed cancer groups (for example, bladder and kidney cancers), from within the broader cancer groups (for example, urological excluding prostate cancer).
  • In the Time to Treatment data, some broader intervals have been used compared to previous versions, combining the intervals 4-5 months with 5-6 months, and 12-15 months with 15-18 months. The <0 category has been renamed 'Before diagnosis' for clarity.
  • HES data has additionally been used to provide some of the ethnicity information recorded in the RCRD data, resulting in increased completeness.


Release 7: 29 September 2021

  • Diagnoses updated to June 2021.
  • An additional metric has been added, the early stage proportion (the proportion of staged cancers diagnosed at stage 1 or 2).


Release 6: 1 September 2021

  • Diagnoses and radiotherapy proportions updated to May 2021.
  • Chemotherapy proportions updated to March 2021.
  • In the RCRD data, an improvement has been made to the method used for estimating the number of cancer diagnoses, with a single diagnosis now being recorded rather than two different diagnoses when some of the data includes an ICD10 code relating to the bone and soft-tissue or unknown cancer groups within a 90 day period. In such situations the bone and soft-tissue or unknown tumour is no longer included in the dataset. This affects data for all months, decreasing the estimated number of diagnoses by around 1% for all malignant cancers, excluding non-melanoma skin cancer (NMSC), for months with more stable data. This corresponds to decreases of around 15% for the bone and soft-tissue cancer group and around 24% for the unknown cancer group.


Release 5: 30 July 2021

  • Diagnoses and radiotherapy proportions updated to April 2021.
  • Chemotherapy proportions updated to February 2021.
  • In the RCRD data, an improvement has been made to the method used for estimating the number of cancer diagnoses, to use a combination of COSD and CWT data. This affects data for all months, increasing the estimated number of diagnoses by around 1.7% for months with more stable data.
  • Stage data has been included for some additional cancers, namely for pancreas (ICD10 C25) within the Upper GI excl. OG cancer group and for lymphoma (C81-86, C88) with the Haematological cancer group.
  • In the data comparisons to previous years, the data from March 2021 onwards is compared to data for the same month in 2019, to avoid comparison to pandemic-affected months in 2020.
  • Charts showing a Time trend have been updated to show data from January 2019 only, to show the more recent data more clearly. The data for 2018 is still available in tables and/or data downloads.
  • This Update log page has been added for improved clarity.


Release 4: 30 June 2021

  • Diagnoses and radiotherapy proportions updated to February 2021.
  • Chemotherapy proportions updated to November 2020.
  • Data for the Routes to Diagnosis breakdown censored to December 2020 due to lower data completeness for more recent months. For more information, see the Data collection and data quality on the Uses and limitations page.


Release 3: 26 May 2021

  • Diagnoses and radiotherapy proportions updated to January 2021.
  • Surgical tumour resection activity and proportions updated to December 2020.


Release 2: 28 April 2021

  • Diagnoses and radiotherapy proportions updated to December 2020.
  • Chemotherapy proportions updated to October 2020.


Release 1: 19 March 2021

  • Diagnoses included up to November 2020.
  • Surgical tumour resection activity and proportions included up to November 2020.
  • Chemotherapy proportions included up to August 2020.
  • Radiotherapy proportions included up to November 2020.

Summary of key results and patterns for England-level data

Introduction

The cancer incidence, surgical tumour resection activity and treatment proportion results reported here are sourced from the Rapid Cancer Registration Dataset. The incidence numbers are likely to be an under-estimate of the actual number which will be recorded in full, gold standard cancer registration data.

The following provides a summary of key results and patterns reported in this dashboard, focusing on England-level data. However, there are many more results available within the dashboard.

Throughout the summary below, and within the dashboard, comparisons are made to previous activity. These comparisons compare data for a given month to data for the same month in a previous year (usually the preceding year is used for this comparison but for March 2021 onwards, data is compared to the same month in 2019 to avoid comparison to pandemic-affected months in 2020). For incidence and surgical tumour resection activity, these comparisons are based on working day adjusted counts.


Incidence: New cancer diagnoses

  • There was a consistent number of estimated new cancer diagnoses recorded in the rapid cancer registrations dataset in the pre-COVID-19 period, up to March 2020 when the number of new diagnoses reached 100% of previous activity for all malignant cancers, excluding non-melanoma skin cancer (NMSC).
  • For April and May 2020, the estimated number of new cancer diagnoses per month dropped, to around two-thirds of the pre-COVID numbers (64% for all malignant cancer excluding NMSC). There were decreases for all cancer groups, with the lowest proportion of previous activity ranging from 42% for prostate cancer to 94% for pancreatic cancer.
  • For June 2020 onwards, the estimated number of new cancer diagnoses increased again from their lowest levels for all cancer groups. By September 2020, the estimated number of diagnoses had reached 95% of previous activity for all malignant cancers excluding NMSC. This includes at least 90% of previous activity for all cancer groups except cervical (87%), endocrine (82%), kidney (88%), melanoma (84%), ovarian (86%), prostate (85%) and testicular (88%) cancers.
  • Since September 2020, the proportions of previous activity for new diagnoses of all malignant cancers excluding NMSC remained relatively similar (95-100%), with a decrease to 93% in February 2021.
  • By cancer group there have been varying patterns since September 2020. For many cancer groups, the number of new diagnoses has been close to previous activity (around 95-105%) for several months. There has also been some months with higher numbers of new diagnoses than previous activity, particularly for colorectal (114-123% between March and May) and Hodgkin lymphoma (110-116% between January and April). However, the proportions of previous activity have generally remained lowest for prostate cancer (75-89% over September to April) and multiple myeloma (80-91% October to April). Some other groups have lower proportions (74-95%) for recent months, but this may reflect lower completeness.
  • For all malignant cancers excluding NMSC, the pattern and size of changes in new cancer diagnoses were similar for most demographic factors, including for both men and women and for all deprivation quintiles. There was an increase in the proportion of diagnoses with unknown ethnicity but, based on diagnoses where it was recorded, changes in the number of new cancer diagnoses appeared similar for all ethnicity groups.
  • The impact on new cancer diagnoses for those aged 0-49 appeared to be smaller than for older age-groups, with new diagnoses of all malignant cancers excluding NMSC dropping in May 2020 to 74% of previous activity for those aged 0-49 compared to lows of between 58% and 62% for April or May for older age-groups. However, after June, as diagnoses increased again, the number of new diagnoses was closer to previous activity for those aged 70-79 and 80+ (97% and 98% respectively for September) than for those aged under 70 (92-94% for September).
  • Routes to Diagnosis is a categorisation of the patient pathways which led to a diagnosis of cancer; these different routes have been shown to be associated with different treatment pathways or outcomes. For all malignant cancers excluding NMSC, the number of new cancer diagnoses through an emergency presentation route decreased, in comparison to previous activity, for March and April 2020 (down to 79% of previous activity for April), but then increased to 100% or more for all months from May 2020 to March 2021, except for 93% in January 2021. In contrast, diagnoses through all other routes remained below 100% for April through to August, with decreases for May 2020 ranging from 13% for diagnoses from screening to 62% for diagnoses through the Two-Week Wait route.


Surgical tumour resection activity

  • There was a reasonably consistent number of surgical tumour resection procedures before the initial COVID-19 lockdown period. For March 2020, the number of tumour resection procedures for all included malignant cancers 1 reached 100% of previous activity.
  • The number of surgical tumour resection procedures per month subsequently decreased to around two-thirds of the previous activity for April to June 2020 for all included malignant cancers.
  • Between April and July 2020, surgical tumour resection activity was much lower than usual for at least two months for all cancer groups, with the lowest monthly proportion of previous activity ranging from 20% for prostate cancer to 84% for liver cancer. However, activity was also lower than usual in March 2020 for some cancer groups, particularly prostate cancer (75%), oesophageal (78%) and cervical (68%) cancers.
  • Since July 2020, surgical tumour resection activity for all included malignant cancers has increased again to 93% for December 2020 and 99% for March 2021, although with a drop to 83% in January 2021.
  • There have been similar increasing patterns since July 2020 for most cancer groups, with the proportion of previous activity reaching at least 90% for two or more months for most cancer groups. Exceptions to this are prostate cancer (with 95% of previous activity for August 2020 but under 90% for all months since then, including 70% in March 2021), lung cancer (with 90% of previous activity for September 2020 and between 69% and 84% for all months since then) and stomach cancer (with 103% of previous activity in June 2020, but between 56% and 84% for other months up to March 2021, with a related pattern for the combined oesophago-gastric cancer group).
  • The pattern and size of changes in surgical tumour resection activity for all included malignant cancers were similar for all deprivation quintiles and all ethnicities (except for an increase in the proportion with unknown ethnicity).
  • For all included malignant cancers, the decrease in surgical tumour resection activity was smaller for patients aged 0-49 (decreasing to 75% of previous activity for June) and larger for those aged 80 and over (decreasing to 50% of previous activity for April).
  • The decrease in surgical tumour resection activity for all included malignant cancers was initially larger for men than for women (dropping for April to 63% of previous activity for men and 76% for women), but activity decreased further for women after April, down to 65% for June. The proportion of previous surgical tumour resection activity was slightly higher for men than for women from June to October, but slightly lower for men from November to February. For March 2021, there were similar proportions of previous surgical tumour resection activity for men (100%) and women (99%). These different patterns may be related to the different mix of cancers for men and women and the patterns seen for different cancer groups, particularly prostate cancer for men and breast cancer for women.

1 For surgical tumour resection activity, all included malignant cancers is based only on cancer groups reported individually for this metric. Surgical tumour resections may be appropriate for some other cancer groups but they are not included here because procedure code lists have not been defined for them.

Early stage proportion

  • In the pre-COVID-19 period, up to March 2020, the proportion of staged cancers diagnosed at stage 1 or 2, based on the rapid cancer registration dataset, remained consistent, varying between 53% and 57% for all staged malignant cancers.
  • The proportion of all staged malignant cancers diagnosed at stage 1 or 2 decreased to 52% for April 2020 and 48% for May, before increasing again to 49% for June, 50% for July and 51% for August and then 54% to 58% for all months from September onwards.
  • For all periods, the proportion of staged cancers diagnosed at stage 1 or 2 varies considerably by cancer group. There are also notable differences by cancer group in the stability of the early stage proportion prior to March 2020 and in changes since then. There was a particular decrease in the percentage of staged cancers diagnosed at stage 1 or 2 for colorectal cancer in April 2020, decreasing to 39% from around 46-51%; this is likely to reflect the initial impact of the pandemic on the bowel cancer screening programme. In comparison, the percentage of staged breast cancers diagnosed at stage 1 or 2 decreased to 81% for April 2020, compared to around 84-87% before this. As stage data isn't currently available from the rapid cancer registration data for cervical cancer, this metric is not available for cervical cancer. For staged gynaecological cancers and melanoma, there did not appear to be any change in the percentage of staged cancers diagnosed at stage 1 or 2.
  • For all staged malignant cancers, the pattern and size of changes in the proportion of staged cancers diagnosed at stage 1 or 2 were similar for most demographic factors, including for both men and women, for all deprivation quintiles and for all ethnicity groups.
  • The impact on early stage proportion for all staged malignant cancers was larger for those aged 50-59 and 60-69 than other ages, likely reflecting the impact on screening. There did not appear to be any change in the early stage proportion for those aged 0-49.
  • Comparing Routes to Diagnosis groups, there did not appear to be any change in the early stage proportion for all malignant cancers for the diagnoses through the Two-Week Wait route, in contrast to a decrease in early stage proportion for those diagnosed through screening, from 84-91% to 68% for May 2020. For emergency presentations, there was a decrease in the early stage proportion, from 28-31% to 22% for May.


Treatment proportions

  • Recent treatment proportions data published here will often be lower than for previous months. This data is based on diagnosis date and the time between diagnosis and treatment means patients diagnosed more recently will not have complete follow-up in the available data; some treatments may not yet have occurred or been recorded.
  • For diagnosis months with complete follow-up, around 36-38% of all malignant cancers excluding NMSC are recorded as receiving a tumour resection, around 28-30% chemotherapy and 25-28% radiotherapy.
  • For cancers diagnosed from January 2020 there was a reduction in the proportion of tumours receiving surgical resection, decreasing from 36-38% of tumours prior to December 2019 to 31% in May 2020. Since then the proportion of tumours receiving tumour resection has increased, returning to 36% of cancers by October 2020. The decrease in the proportion of tumour resections was more pronounced for certain cancer sites. For example, the proportion of tumour resections for lung cancer decreased to between 11% and 12% between May and August 2020 compared to between 16% to 18% throughout 2019 and 15% for October 2020.
  • For patients diagnosed between February 2020 and March 2020 there is a decrease in the proportion recorded as receiving chemotherapy (25% in March 2020), with an increase for those diagnosed between May and August 2020 (32-33%). A similar pattern is seen for this period for most cancer groups.
  • For all malignant cancers excluding NMSC and patients diagnosed in 2020, the proportion of patients recorded as receiving radiotherapy has remained similar to previous years (24-27%). However, for some cancer groups, there appears to have been a slight peak above expected levels of radiotherapy for diagnoses from March to May 2020. For example, 66% of head and neck cancer patients diagnosed in May 2020 are recorded as receiving radiotherapy, compared to 55% of those diagnosed in December 2019 and 61% in June 2020.
  • For all malignant cancers excluding NMSC, there were similar changes to the patterns of treatment proportions by many demographic factors, including for men and women, for all deprivation quintiles and for all ethnicities.
  • The changes in the proportion of patients recorded as receiving chemotherapy for diagnoses from December 2019 to June 2020 appear similar for most Routes to Diagnosis, although there appears to have been less change for those diagnosed through the emergency presentation route, for all malignant cancers excluding NMSC.
  • For all malignant cancers excluding NMSC, it appears there was a decrease in the proportion of those diagnosed through screening who were recorded as receiving radiotherapy or a tumour resection for May 2020 to July 2020. However, this seems to be explained by changes in the relative proportions of breast, colorectal and cervical cancers diagnosed through screening during these months (with the largest decrease for breast cancers) and a decrease in the proportion of breast cancers diagnosed through screening who were recorded as receiving radiotherapy or a tumour resection.




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Treatment proportions data

Recent treatment proportions data is often lower than previous months because some treatments may not yet have occurred and been recorded. For more information, see the Data collection and data quality section on the Uses and Limitations page, the Data timeliness section on the Introduction page or the Time to treatment - Demographics page. In the following graphs, the dotted lines represent the months that will not have complete follow-up in the available data.













New cancer diagnoses (working day adjusted), England, January 2018 to September 2021

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Tumour resection procedures (working day adjusted), England, January 2018 to March 2021


Early stage proportion, England, January 2018 to September 2021


Tumour resection proportion, England, January 2018 to March 2021


Chemotherapy proportion, England, January 2018 to August 2021


Radiotherapy proportion, England, January 2018 to September 2021


New cancer diagnoses (observed), England, January 2018 to September 2021


Tumour resection procedures (observed), England, January 2018 to March 2021

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Treatment proportions data

Recent treatment proportions data is often lower than previous months because some treatments may not yet have occurred and been recorded. For more information, see the Data collection and data quality section on the Uses and Limitations page, the Data timeliness section on the Introduction page or the Time to treatment - Demographics page. In the following graphs, the dotted lines represent the months that will not have complete follow-up in the available data.













Proportion of previous activity, new cancer diagnoses, England, January 2018 to September 2021

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Proportion of previous activity, tumour resection procedures, England, January 2018 to March 2021


Proportion of previous activity, early stage proportion, England, January 2018 to September 2021


Difference from previous year, tumour resection proportion, England, January 2018 to March 2021


Difference from previous year, chemotherapy proportion, England, January 2018 to August 2021


Difference from previous year, radiotherapy proportion, England, January 2018 to September 2021

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Click below to download a copy of the data:


Download time trend data for selected cancer group and demographic factor

Download time trend data for all cancer groups and demographic factors

Download annual comparison data for selected cancer group and demographic factor

Download annual comparison data for all cancer groups and demographic factors

This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS Digital.

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Click below to download a copy of the data:


Download data for selected cancer group and demographic factor

Download data for all cancer groups and demographic factors


This work uses data that has been provided by patients and collected by the NHS as part of their care and support. The data is collated, maintained and quality assured by the National Disease Registration Service, which is part of NHS Digital.

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Treatment proportions data

Recent treatment proportions data is often lower than previous months because some treatments may not yet have occurred and been recorded. For more information, see the Data collection and data quality section on the Uses and Limitations page, the Data timeliness section on the Introduction page or the Time to treatment (Proportion of cases) tab. In the following graphs, the dotted lines represent the months that will not have complete follow-up in the available data.















New cancer diagnoses (working day adjusted), January 2018 to September 2021

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Tumour resection procedures (working day adjusted), January 2018 to March 2021



Early stage proportions, January 2018 to September 2021



Tumour resection proportion, January 2018 to March 2021



Chemotherapy proportion, January 2018 to August 2021



Radiotherapy proportion, January 2018 to September 2021



New cancer diagnoses (observed), January 2018 to September 2021



Tumour resection procedures (observed), January 2018 to March 2021



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Treatment proportions data

Recent treatment proportions data is often lower than previous months because some treatments may not yet have occurred and been recorded. For more information, see the Data collection and data quality section on the Uses and Limitations page, the Data timeliness section on the Introduction page or the Time to treatment (Proportion of cases) page. In the following graphs, the dotted lines represent the months that will not have complete follow-up in the available data.













Proportion of previous activity, new cancer diagnoses, January 2018 to September 2021

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Proportion of previous activity, tumour resection procedures, January 2018 to March 2021



Proportion of previous activity, early stage proportions, January 2018 to September 2021



Difference from previous activity, tumour resection proportion, January 2018 to March 2021



Difference from previous activity, chemotherapy proportion, January 2018 to August 2021



Difference from previous activity, radiotherapy proportion, January 2018 to September 2021



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Treatment proportions by type of treatment (Independent), January 2018 to March 2021

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Treatment proportions by type of treatment (Combination), January 2018 to March 2021