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.
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
- the tool includes all patients diagnosed or treated in England from all age groups.
- the tool covers new diagnoses and their treatment, and also all surgical tumour resection
activity for the period 1 January 2018 onwards.
- 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.
- 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.
- 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.
- 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.
- data is available with breakdowns by demographic factors, namely:
- Age - age group at diagnosis (<50, 50-59, 60-69, 70-79, 80+)
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)
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
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.
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:
Exploring the charts
- 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
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
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).
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
This email address can be used for general enquiries to NDRS, please do not include sensitive or patient identifiable information.
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
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
section on the
page) and the agreed treatment interval for the cancer group (see the
Treatment definitions and proportions
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:
Comparison to full, gold standard cancer registration data
- 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  and of people urgently referred for suspected cancer .
With people encouraged to continue reporting worrying symptoms to their doctor and doctors encouraged to refer patients as usual , the number of
referrals increased over subsequent periods although remaining lower than usual for several months .
- 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  and radiotherapy treatments  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 .
- 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 . 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
- 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.
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
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.
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.
- 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
 Clinical guide for the management of patients requiring endoscopy during the coronavirus pandemic. NHS England and NHS Improvement, 2 April 2020. Now available from
 Clinical guide for triaging patients with lower gastrointestinal symptoms. NHS England and NHS Improvement, 16 June 2020.
 Appointments in General Practice - April 2020. NHS Digital, 28 May 2020.
 Mahase E. Covid-19: Urgent cancer referrals fall by 60%, showing brutal impact of pandemic. BMJ 12 June 2020; 369; doi:
 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.
 Mahase E. Cancer treatments fall as referrals are slow to recover, show figures. BMJ 13 October 2020; 371; doi:
 NG161: COVID-19 rapid guideline: delivery of systemic anticancer treatments. NICE, 20 March 2020 updated 27 April 2020.
 NG162: COVID-19 rapid guideline: delivery of radiotherapy. NICE, 28 March 2020.
 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:
 Clinical guide for the management of non-coronavirus patients requiring acute treatment: Cancer. NHS England and NHS Improvement, 23 March 2020. Now available from
 Coronavirus guidance from a variety of professional societies. See longer list below.
 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.
 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.
 Letter regarding the 'Second phase of NHS response to COVID19' from Simon Stevens and Amanda Pritchard, 29 April 2020.
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.
; Royal College of Surgeons for England, COVID-19 Guidance.
; The Royal College of Radiologists, Coronavirus (COVID-19): cancer treatment documents
Brain and CNS:
British Neuro-Oncology Society, Treatment Pathways and Guidance.
; The Society of British Neurological Surgeons, COVID-19 Guidelines.
Associate of Breast Surgery, COVID-19 resources.
The Association of Coloproctology of Great Britain and Ireland, ACPGBI latest COVID-19 updates.
British Gynaecological Cancer Society, COVID19 Resources.
Head and neck:
British Association of Head & Neck Oncologists, Clinician Area.
British Thoracic Society, COVID-19.
; Society of Cardiothoracic Surgery in Great Britain and Ireland, COVID-19.
British Associations of Dermatologists, Advice for Dermatology HCPs during Covid-19 pandemic.
Upper GI, including Oesophago-gastric:
British Society of Gastroenterology, COVID-19 Guidance & Advice.
; Association of Upper Gastrointestinal Surgery of Great Britain and Ireland, AUGIS Guidelines.
Urological, including Prostate:
The British Association of Urological Surgeons, Coronavirus & COVID-19.