This dashboard provides a suite of measures on systemic anti-cancer therapies (SACT) activity relevant to the COVID-19 pandemic. The intended audience is anyone with an interest in how anti-cancer therapies has been impacted during the COVID-19 pandemic. Other interested audiences include those planning cancer services and those campaigning for cancer patients. The data may also help to highlight areas of particular concern, to direct future research activities.
This data should not be used as a performance metric to compare activity between Cancer Alliances. In addition to the numerous clinical factors which typically inform a treatment decision, clinicians will also have to consider issues such as staffing shortages, as well as the patient's socio-demographic characteristics. Therefore, there is no straightforward 'like for like' comparison between geographies.
Many thanks to the clinicians who supported this project.
Activity Period & Data Quality
Activity period - the dashboard covers activity (i.e. regimen and cycle start dates and administration date) from the 1st of January 2019 to 31st of October 2020. Not all trusts will have data for all months (detailed below).
Update frequency - the dashboard will be updated to include new months of newly submitted data when submission rates allow. The most recent update date was May 28th 2021 and derives from the National Disease Registration Service (NDRS) cancer analysis system snapshot CAS2105. This snapshot includes an update to regimen benchmarking which adds a small amount of activity in later periods.
As a result of the normal submission schedule, NHS trusts' data appear in this dashboard months after the activity occurred. Some trusts may be ahead of schedule and others may have late submissions. Therefore, not all trusts will have data for all the activity months. In this dashboard only data from months with greater than 90% of NHS Trusts reporting are included. Trust level data is not presented here, the data is aggregated to National and Cancer Alliance levels, however it is still important to note the NHS Trust reporting rates, as they provide all the data shared here.
Approximate completion for trust submissions by month for the COVID-19 period is:
March 2020: 99% of trusts have submitted data
April 2020: 96% of trusts have submitted data
May 2020: 96% of trusts have submitted data
June 2020: 94% of trusts have submitted data
July 2020: 96% of trusts have submitted data
August 2020: 96% of trusts have submitted data
September 2020: 96% of trusts have submitted data
October 2020: 91% of trusts have submitted data
A few trusts have missing activity for earlier months.
Trusts are currently in transition to the revised version of the SACT dataset, SACT V3. Most data items used in this report are unaffected by the change. Treatment intent is one of the affected items as there are now different intent fields in SACT V2 and V3. For the purposes of this dashboard, these have been combined into a single intent of treatment field, but the transition can result in some unexpected trend such as the up tick in intent of treatment describes as "other" increasing through 2019 and into 2020, potentially due to the great number of options available to code intent in v3.The SACT v3 data dictionary offers more details.
Activity Measures and Aggregation Methods
Measures of SACT activity included:
Measures that are a count of unique drug administrations. In a course of treatment patients will receive multiple administrations of anti-cancer drugs, often in combination. Each individual drug and administration are recorded separately. Drugs may be administered by various routes, including IV (intra-venous), oral and subcutaneous.
Monthly new patients & Monthly patients treated by year of latest diagnosisMeasures of activity based on numbers of patients (patient count) - this is a count of unique patient ID. Where a patient has received multiple treatment administrations or regimens, they are counted only once. Where a patient is treated in more than one Cancer Alliance or for more than one tumour type, they may be counted twice in some instances.
Monthly RegimensCounts of unique regimens with activity in the selected time period. A regimen is defined as a course of treatment involving multiple administrations of anti-cancer drugs. Regimens are usually administered in a series of cycles over several months. Where the same regimen appears in several months it will appear in the count of all months for which there was activity.
Important details on aggregation and totals
Measures offered in tab 3 ‘Monthly Activity’ provide monthly counts where a patient is counted once per month, even if the patient receives multiple regimens or administrations in the same month. Whereas, a regimen will be counted once in each month in which at least one administration within the regimen is received, and administrations will be counted in the month they are received. Some patients may receive treatment for more than one regimen in a single month. Many patients will receive multiple separate administrations in a single month.
Additional breakdowns are available in tab 4 ‘Monthly Activity + one-way breakdown’ and tab 5 ‘Monthly Activity + subpopulation breakdown’. In certain situations, in these tabs, a record may be counted more than once. For example, if a patient has two different cancer diagnoses, e.g. breast cancer and lower GI cancer both treated in the same month, such a patient will be counted separately under each tumour group in the tumour type breakdown, once under breast cancer and once under lower GI. Whereas that same patient will only be counted once under the total monthly counts in tab 3.
As another example, if an individual receives a SACT regimen including an administration with a biological modality and an administration with a cytotoxic modality in the same month, these two regimens would be counted separately under a regimen-based count with a modality breakdown.
The degree of double counting increases as more breakdown levels are offered. A consequence of this is that adding up subtotals from tab 4 and tab 5 will not match the tab 3 totals. As such we advise using the minimum level of data breakdowns to match your need. To align with this, the data download button on each tab will extract the data along the breakdowns available in that tab.
For users who also have access to this data via the CancerStats2 portal, please note that alternative aggregation methods were taken in this public dashboard to protect data privacy. As a consequence, some aggregations will not be available or will not match when comparing the two reports. In such cases, differences arise due to alternative approaches to counting individual patient information, i.e. for patients with multiple tumour types.
Details of Data Items Included
This dashboard includes all cancer patients from all age groups.
Activity date: is defined as the administration date. For the small percentage of records where an administration date is not supplied cycle start date is used instead.
Exclusions: treatments that are not SACT (e.g. fluids and other supportive treatments; G-CSF, anti-emetics, erythropoietin, cardioprotective agents, denosumab). Steroids and bisphosphonates are excluded.
Geography: All England and Cancer Alliance are based on the treating NHS trust where the treatment began.
Tumour group: based on the patient tumour group category and is derived from the clinical assigned code from the ICD10 coding system.
- Brain/CNS (C47, C69-C72, D32, D33, D42, D43)
- Breast (C50, D05, D24 )
- Gynaecological (C48, C51-C58, D25, D26, D28, D39)
- Lower GI (C18-C21, C26, D12, D13)
- Upper GI (C15-C17, C22-C25, D00, D13, D37)
- Head and Neck (C00-C14, C30-C32, D02, D10, D11, D14, D31, D38)
- Lung (C33, C34, C37-C39, C45, D142, D143, D144, D15, D19)
- Sarcoma (C40, C41, C46, C49)
- Skin (C43, C44, D03, D04)
- Urology (C60- C68, D074, D076, D29, D30, D40, D41)
- Leukaemia (C91-C95, C962, C964, C968)
- Lymphoma (C81-C86, C88, C913, C914, C916-C919)
- Myeloma (C90, D472, E85)
- Other haematology (C922, C931, C933, C946, C96, D45-D47)
- Other cancers (C73-C80, C97, D01, D07, D09, D16-D18, D20, D21, D34-D36, D48)
- Benign / in situ (D22, D23, D291, D292, D300-D304, D06, D073, D075)
Age group: based on the patient's age at the start of the regimen.
- >40
- 40-49
- 50-59
- 60-69
- 70-79
- 80+
Intent of treatment: based on a clinical assigned intent of treatment. As above this represents a combination of intents submitted in SACT v2 and SACT v3, and is simplified to 'Curative', 'Palliative', 'Adjuvant', 'Neo-adjuvant' and 'Other'. Where both curative and palliative codes are supplied for the same regimen, the intent is assumed to be palliative overall. 'Other' represents an unknown code. When offered as an additional breakdown on tab 5 intent has been further grouped to Curative, Palliative and Other; Other representing Adjuvant, Neo-Adjuvant, and unknown codes.
Administration route: represents the method the treatment was delivered to the person living with cancer and is simplified to IV (intravenous), oral, subcutaneous or other.
Modality: represents the classification of the drug or drug combinations used. i.e. is the drug classified as cytotoxic, biological therapy or immunotherapy. This classification was provided by SACT clinical support and covers the most common drugs used. Drugs not classified appear as 'other'.
Year of diagnosis: is the year in which the a Cancer diagnosis was registered, for patients with multiple cancer diagnoses the latest year is taken. Please note that "missing" data from the field may in some cases represent provisional data resulting from a delay in confirmation of the diagnosis date. The gold standard registration process relies on additional data sources, enhanced follow-up with trusts and expert processing by cancer registration officers which takes time.
Important note on cancer alliance breakdowns:
Data at specific Cancer Alliance level is offered on Tab 3 and Tab 4. In some cases the breakdowns of measures for Cancer Alliances will have less levels or will be grouped together further than what is offered at national level. For example Cancer Alliance breakdowns at >40 and 40-49 are combined to >50 age group and the number of tumour groupings provided is restricted. These steps were taken to avoid disclosing small number counts that might represent a privacy risk.
Adjusting the dashboard?
Dashboard filters can be found in the sidebar to the left of the main panel. These filters allow the data to be tailored based on the geography of interest, measure of activity, tumour group, age group, intent of treatment, administration route and drug modality. Adjusting these filters will change the data in all charts and tables in the dashboard. Please use the filters to tailor the charts to your needs, but note that not all combinations will be available.
The data is also available for download through the download data button found at the bottom of the side bar.
There are five tabs found at the top of the main panel, beneath the banner
2. Summary - offers an overview of the trends observed in the data and additional context
3. Monthly activity - offers a graph and table displaying overall data for each of the activity measures, allowing comparison of 2019 and 2020 activity levels for the geography of interest
4. Monthly activity and one-way breakdown - breaks the data down further along different measures (e.g. Age range). Graphs and tables again show 2019 and 2020 data for comparison.
5. Monthly activity and subpopulation breakdown - this tab offers multiple options to more precisely cut the data into specific subpopulation of interest, this is only possible for National level data.
Note: adding up the subtotals found in the fourth and fifth tabs will not always sum to the same number as found in the third tab. Tabs 4 and 5 will count treatments to patients with multiple tumours or under different intents once per event, Tab 3 will only counts unique patients once (more details above).
Feedback
It is important that these reports are dynamic. We aim to continue to adapt and improve them to meet the user needs.
Please send your feedback to SACT@phe.gov.uk
Use of Patient Data
Public Health England (PHE) has been granted specific legal permission to collect information about patients with cancer for specific purposes including health improvement and service provision. Permission was granted to PHE through Section 251 of the NHS Act 2006. This support is reviewed annually by the Confidentiality Advisory Group of the Health Research Authority. PHE releases are subject to strict confidentiality provisions in line with the requirements of the Common Law Duty of Confidentiality, the General Data Protection Regulation (EU) 2016/679 and the 7 Caldicott principles.
These services and functions are carried out at the National Disease Registration Service, a part of PHE.
For enquiries on this or general enquiries to the National Disease Registration Service contact NCRASenquires@phe.gov.uk
The data covered here covers multiple different measures of activity for systemic anti-cancer treatments in England; for the sake of clarity the statements below refer to Monthly Activity unless otherwise stated. Monthly Activity measures administrations of therapy, i.e. in the case of a course of treatment involving multiple injections of a drug, each injections (administration) is counted individually. The guidance page has more details on the meaning and source of the different measures.
Update: 28-05-2021
Changelog:
- No additional months added; the latest month of data available is for October 2020.
- Data from previous months have been revised with newly available data.
Data trends update:
Patient and new patient counts:
- In October 2020, 94% of patients received SACT (systemic anti-cancer therapy) compared to October 2019. That figure is lower than the September figure (98%) and is similar to the June, July and August figures (92%, 92% and 93%, respectively).
- The number of new patients receiving SACT in October 2020 was 83% compared to October 2019, this is also below the September figure (92%).
- For the period April to October 2020, over 14,000 fewer new patients started to receive SACT compared to the same period in 2019. Considering all patients, including those continuing treatments, over 54,000 fewer patients have been treated.
Activity / administration counts:
- SACT activity in October 2020 (87% compared to October 2019 activity) had improved since April (82%) but remained below the pre-pandemic levels and was comparatively lower than the previous month; September 2021 activity was 96% compared to September 2019.
- In October 2019, there were over 226,000 administrations of SACT. In October 2020, there were 29,000 fewer administrations, with around 197,000 recorded.
- In total, there were over 205,000 fewer administrations from April to October in 2020 compared to the same period in 2019.
Update: 28-04-2021
Changelog:
- Additional month of data added for October 2020.
- Data from previous months have been revised with newly available data.
Data trends update:
Patient and new patient counts:
- In October 2020, 91% of the number of patients received SACT compared to October 2019. That figure is lower than the September figure (96%) and is similar to the June, July and August percentages (91%, 90% and 91%).
- The number of new patients receiving SACT in October 2020 was 80% compared to October 2019, this is also below the September figure (88%).
- For the period April to October 2020, over 15,000 fewer new patients started to receive SACT compared to the same period in 2019. Considering all patients, including those continuing treatments, over 65,000 fewer patients have been treated.
Activity / administration counts:
- Systemic anti-cancer activity in October 2020 (84% of Oct of 2019 activity) had improved since April (81%) but remained below the pre-pandemic levels and was comparatively lower than the previous month, September 2021 activity was 94% of September 2019.
- In October 2019, there were over 226,000 administrations of systemic anti-cancer therapies. In October 2020 there were 35,000 fewer administrations, with around 192,000 recorded.
- In total, there were over 230,000 fewer administrations from April to October in 2020 compared to the same period in 2019.
Update: 01-04-2021
Changelog:
- Additional months of data added for August and September 2020.
- Data from previous months have been revised with newly available data.
Data trends update:
Activity / administration counts:
- Systemic anti-cancer activity in August 2020 (82%) and September (93%) has improved since April but remain below the 2019 and pre-pandemic levels.
- In September, all tumour groupings had recovered to or above 80% compared to 2019, except for cancers grouped under "Sarcoma" or "Other Cancers" (74% and 69%).
- Several tumour groupings had recovered close to or have exceed the 2019 activity (Other haematology - 103%, Leukaemia - 99%, Breast - 97%, Upper GI - 97%, Urology - 96%, Gynae - 96%).
- Immunosuppressive treatment administrations dropped to a low of 69% in April and since recovered up to 89% in September of 2019 administrations
Patient and new patient counts:
- Monthly patient counts remained below 2019 levels but were up to 95% in September, with the highest counts seen since April. Monthly new patients had recovered less; September 2020 saw 87% of the number of new patients receiving SACT versus September 2019.
- There was variation by age group, with the greatest reduction compared to 2019 in those aged 70-79 and 80+ (42% and 51% in April, respectively). However, these age groups have since recovered to the range seen for other age groups, 88% and 90%, in September.
Data trends in reported SACT activity 2019 vs. 2020
Trends in overall activity:
- The number of systemic anti-cancer treatments overall in January and February 2020 were higher than the treatments in the same month in the previous year (105% and 106% respectively).
- From April 2020 onwards, the number of systemic anti-cancer treatments decreased compared to the counts before the first Covid-19 restrictions. It was at its lowest in April (80%) and May (72%) compared to the same period in 2019. [1]
- Systemic anti-cancer activity began to increase in June 2020 (89%) and July (82%), compared to 2019 activity, but is still below the 2019 and pre-pandemic activity.
Other patterns in the data worth noting:
Tumour Groupings:
- Most tumour groups followed a similar pattern in systemic anti-cancer activity with decreases in activity in April and May 2020 followed by a subsequent gradual increase.
- No tumour groups dropped below 60% compared to 2019 in any month so far, except for cancers grouped under "Head & Neck" or "Other Cancers" which dropped to their lowest in May (49% and 48%).
- Breast remained above 80% of the previous year’s activity in April 2020 (93%); as did skin (89%), leukaemia (90%), lymphoma (82%), myeloma (83%) and other haematological cancers (99%).
Age Groups:
The older age groups showed larger and more persistent decreases in systemic anti-cancer activity compared to other age groups
Intent of Treatment:
For monthly activity there is a downward trend on curative treatments with limited recovery in June, followed by another drop in July (May-Jun-Jul: 75%, 87%, 77%) whereas palliative treatments showed a sharper initial decline but has recovered towards similar levels as curative (May-Jun-Jul: 67%, 83%, 78%).
Treatment Modality:
When compared to 2019, all treatment modalities decreased in May and partially recovered in July. Cytotoxic modality dropped lowest to 66% in May and remained down at 77% of previous years activity in July.
Route of administration:
There were persistent decreases in intravenous and subcutaneous administered treatments, while orally administered treatments dropped to 89% of 2019 activity in May but subsequently recovered to a level similar to or above the previous year’s activity.
Other Measures of Activity:
Most of these changes in Monthly Activity were consistent across the number of treatments delivered, and the number of patients treated, both as part of their initial and continued treatment.
General notes:
- Data is aggregated from NHS Trust level reporting; we have only shown data for months where more than 90% of Trusts have completed their data submissions. This is currently up to and including July 2020.
- The number of patients treated, and the total treatments administered were higher in January and February 2020 than in 2019. Given these increases in early 2020, a simple month-by-month comparisons might be overestimating the recovery.
- The data is hospital-based activity and is known to under-report the volume of hormonal therapy treatments in comparison to primary care prescribing data
What's the context of these trends?
The SACT data presented here cannot directly address the cause of the reduction it describes. Decreases in the number of people being diagnosed with cancer, changes in the number of patients seeking treatment, and/or any delays to the start of cancer treatments are likely to affect overall systemic anti-cancer activity levels, as well as a range of clinical factors. Some potential impacting factors are detailed below.
Changes to diagnosis rates:
- Cancer diagnosis rates have likely been affected by additional pressures on imaging capacity and endoscopy. Additional infection control measures may have reduced overall capacity and COVID-19 may have also had direct competitive demand on these services.[3, 4].
- 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 initial lockdown period in the numbers of GP appointments [5] and of people urgently referred for suspected cancer [5,6]. With people encouraged to continue reporting worrying symptoms to their doctor and doctors encouraged to refer patients as usual [7], the number of referrals increased over subsequent periods although remain lower than usual for several months [8].
- For breast, colorectal and cervical cancers, the number of 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 towards normal levels ongoing.[9]
Changes to treatment patterns and prioritisation:
- National guidelines were published to inform the provision of systemic anti-cancer [9] and radiotherapy treatments [10] 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, and there is evidence of this impacting treatment.[11]
- NICE issued guidelines in March 2020 that sought to maximise the safety of patients with cancer and make the best use of NHS resources during the COVID-19 pandemic, while protecting staff from infection.[8]
- 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 [10].
- A variety of tumour group or specialism related guidelines [1, 2] 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]. 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.
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 link
2. Clinical guide for triaging patients with lower gastrointestinal symptoms. NHS England and NHS Improvement, 16 June 2020. link
3. Appointments in General Practice – April 2020. NHS Digital, 28 May 2020. link
4. Mahase E. Covid-19: Urgent cancer referrals fall by 60%, showing "brutal" impact of pandemic. BMJ 12 June 2020; 369; doi: link
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. link
6. Mahase E. Cancer treatments fall as referrals are slow to recover, show figures. BMJ 13 October 2020; 371; doi: link
7. NG161: COVID-19 rapid guideline: delivery of systemic anticancer treatments. NICE, 20 March 2020 updated 27 April 2020. link
8. NG162: COVID-19 rapid guideline: delivery of radiotherapy. NICE, 28 March 2020. link
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: link
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 link
11. Spencer, K., Jones, C. M., Girdler, R., Roe, C., Sharpe, M., Lawton, S., … Morris, E. (2021). Articles The impact of the COVID-19 pandemic on radiotherapy services in England , UK : a population-based study. Lancet Oncology, 2045(20), 1–12. link
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. link
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. link Letter regarding the ‘Second phase of NHS response to COVID19'from Simon Stevens and Amanda Pritchard, 29 April 2020. link
This tab contains overall monthly data for each of the activity measures
Details of data currently being displayed based on side bar selections:
2019 vs. 2020 comparison table
This tab contains monthly activity data for each of the options under a single additional breakdown of choice
Reminder: the additional breakdowns on this tab may result in the sum of subtotals not always equating to the totals from other tabs. Please return to the guidance tab to review the details on aggregation and totals.
Details of data currently being displayed based on side bar selections:
please note: the y-axis here adapts to the data and are not the same across graphs, this was done to highlight trends and trajectories in each data item, please keep this in mind when comparing raw counts, and remember that the data is available to download should you wish to explore deeper.
2019 vs. 2020 comparison table
This tab contains monthly activity data for subpopulations defined by your choices in the sidebar
Reminder: the additional breakdowns on this tab may result in the sum of subtotals not always equating to the totals from other tabs. Please return to the guidance tab to review the details on aggregation and totals.