National Audit of Metastatic Breast Cancer
Find out more about the audit of metastatic breast cancer
The audit will look at the care that patients are receiving in England and Wales, in order to identify any shortfalls, and try to work out how to improve them.
One of the challenges involved in gathering data on metastatic breast cancer is that these patients are not automatically recorded on the national cancer registries. This audit will try to collect these data in a systematic and comprehensive way.
One focus will be to look at specific groups of patients who have the most difficult problems. One of the clinical co-leads on the audit David Dodwell, says that should include patients at each end of the age range – younger and much older patients.
It may also include patients with triple negative breast cancer, and those with brain metastases, which are very difficult to treat.
Since 1st October 2022 NAoMe have been working to set up their governance and infrastructure, and to put in place the project team, including Clinical Leads. They have conducted a scoping exercise to inform priorities for the audits and are analysing the survey results.
All patients diagnosed with metastatic breast cancer from 1st January 2015 onwards in NHS hospitals within England and Wales will be eligible for inclusion. This includes patients diagnosed with metastatic breast cancer at initial presentation as well as those diagnosed with metastases after an initial non-metastatic breast cancer diagnosis i.e. at recurrence or progression.
Similar to the previous NABCOP audit, the NAoMe will wish to limit any additional demands on Trusts and will not directly 'collect' clinical patient data. Instead the audit will use existing sources of patient data routinely collected by national organisations in England and Wales. NAoMe will publish a minimum dataset in 2023
David Dodwell, Clinical Lead (Oncology), National Audit of Metastatic Breast Cancer
Since 1st October 2022 NAoPri have been working to set up their governance and infrastructure, and to put in place the project team, including Clinical Leads. They have conducted a scoping exercise to inform priorities for the audits and are analysing the survey results.
All patients diagnosed with metastatic breast cancer from 1st January 2015 onwards in NHS hospitals within England and Wales will be eligible for inclusion. This includes patients diagnosed with metastatic breast cancer at initial presentation as well as those diagnosed with metastases after an initial non-metastatic breast cancer diagnosis i.e. at recurrence or progression.
Similar to the previous NABCOP audit, the NAoMe will wish to limit any additional demands on Trusts and will not directly 'collect' clinical patient data. Instead the audit will use existing sources of patient data routinely collected by national organisations in England and Wales. NAoMe will publish a minimum dataset in 2023.
The clinical leads for NaoMe, who will guide this process, are as follows:
The first annual report will be produced in 2024
There are numerous reports of suboptimal care in the UK for older patients with breast cancer. This is thought to account for a substantial portion of the gap in survival for patients with breast cancer in the UK compared to other developed countries.
NABCOP data suggests that around 90% of patients aged 70+ with ER+ EIBC are likely to be fit enough to undergo initial surgery (approximately 90% of ER-older patients have surgery). Significant (>2 SD) differences from a 80% use of initial surgery in a Breast Unit in this population of patients aged 70+ with ER+ EIBC would be of concern.
There will be instances when diminished patient cognition, medical fitness or the presence of frailty or limited life expectancy, suggest surgery is not the preferred pathway. PET may be appropriate in these circumstances in full transparent discussion with the patient and their family and carers. Deferred surgery following a defined period of PET for a specific reason such as tumour downstaging, medical optimisation which is protocol based or involvement in approved clinical trials is reasonable but the use of PET for fit patients or those with relatively minor co-morbidity outside these circumstances is discouraged.
The NABCOP project team has devised a simple, pragmatic single A4 sheet assessment aid for completion at their initial diagnostic clinic visit in all patients over 70 years, which would further inform the patient discussion at the Diagnostic MDT.
The individual component parts of the form are mandatory, returnable data items on every Trust's COSD returns from 1st April 2020.
- Email: breastcanceraudits@rcseng.ac.uk
- Twitter: @NAoMe_news
- Visit the NAoMe Website
