Core – Acute oncology

This is a new section for COSD v9 and is designed to capture Acute Oncology (AO) episodes within a Trust.

The purpose of these items is to capture the unplanned care cancer patients receive in an Acute care environment. These data are only for collection by those Hospitals with an Acute Oncology Service (AOS) in place.

The data in the following AO section will be focussed on Patients with an emergency attendance or admitted patients (where the patient was in a bed for one or more nights).

Patients to include are those who were:

• assessed and then admitted
• assessed and sent to their usual place of residence
• assessed as an Admitted Patient after an emergency attendance and kept in
• assessed as an Admitted Patient after an emergency attendance and discharged to their usual place of residence

The assessment will have been ‘face to face’ with the patient (rather than by phone) and carried out by Nursing or Medical staff who are contracted members of the local AOS or trained by the AOS to provide appropriate levels of care and decision making on behalf of the AOS.

If more than one assessment takes place during a patient’s AO episode, each assessment should be reported as an individual record, even if the assessments share the same date; it is important all data is completed for each assessment to provide the complete picture for each patient.

These data are generally collected by the AOS as part of their day to day activity and are used in the compilation of their Quality Surveillance (peer review) returns for Acute Oncology, Neutropenic Sepsis, CUP and MSCC activity and targets. If not all items are directly collected by your AOS, they can be derived using existing data collected for COSD, HES and by your Emergency Department.

For AO care provided by Nursing or Medical staff trained by the AOS but not actually contracted to the AOS, their activity should also be included in the COSD Acute Oncology submission to ensure all AO type activity is accounted for.

These data have been chosen for collection within COSD, rather than the Systemic Anti-Cancer Therapy (SACT) dataset, due to the points in the pathway not always being directly linked to a systemic anti-therapy treatment.

May be multiple occurrences per record (0..*)

Start of repeating item - Patient type

End of repeating item - Patient type

AOS Patient and Data Flow

The following flow chart helps identify whether your Trust will be responsible for submitting these data items as part of their COSD submission. The flow assumes your Trust will provide the patient’s cancer care - if the patient is referred to another Provider for management, that Trust will be responsible for creating records and a COSD submission.

The final 2 steps in flow chart below help you understand if a patient should be on a non-primary patient pathway (at your Trust) or if the data should be sent to another provider, as the patients cancer care is currently managed by that Trust.

The flowchart below provides guidance on how to interpret the acute oncology data items. The text from the flowchart follows the image.

Step 1: the patient is seen by AOS.

Is the patient known to Cancer Services? 

If yes: update patient cancer record.

If no, step 2: is this a new cancer diagnosis?

If yes: create a new cancer referral.

If no, step 3: is the patient on a non-primary pathway?

If yes: create a new non-primary cancer referral.

If no: send AO encounter details to Provider overseeing the cancer care.

Acute Oncology Assessment Date

This is a new data item for v9. This is the date the oncology assessment was carried out.

Additional supporting information includes

If more than one assessment has taken place during the AO episode, supply the date of each assessment, along with all the additional data items laid out below.

AO assessments carried out by AOS and other medical staff trained to provide AO care (but not actually members of the AOS).

Organisation Site Identifier (Acute Oncology)

This is a new data item for v9. The ‘Organisation Identifier of the organisation acting as a Health Care Provider.

Additional supporting information includes:

• this data item will identify the location of the hospital or cancer treatment centre in which the patient was assessed
• the hospital-specific code of where the assessment took place should be recorded rather than the Trust level code

Assessment Location

This is a new data item for v9. The location where the Acute Oncology (AO) assessment was performed within the health care provider.

Additional supporting information includes the following:

Emergency Care Department:

• this would be chosen if the patient was in an emergency care department chair or bed, admitted or not, when the AOS assessment was carried out

Medical Assessment Unit:

• this would be chosen if the patient was in a Medical Assessment Unit chair or bed, admitted or not, when the AOS assessment was carried out

Emergency Ambulatory Care Unit:

• this option would be chosen if the patient was assessed in an Emergency Ambulatory Care Unit when the AOS assessment was carried out
• a new term for this activity is Same Day Emergency Care, which represents the activity which would take place in an Emergency Ambulatory Care Unit

Ward:

• this would be chosen if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

Out-Patient Clinic:

• this would be chosen if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

Dedicated Acute Oncology Bed/Chair:

• this would be chosen if the patient was assessed whilst in a dedicated AO bed or chair - admitted or not, when the AOS assessment was carried out

Day Case Unit:

• this would be chosen if it was the most appropriate selection given the other options available for where the AOS assessment was carried out

Chemotherapy Unit:

• this would be chosen if it was the most appropriate selection to make given the other options available for where the AOS assessment was carried out, inpatient or not

Other:

• this option would be chosen if none of the other options were appropriate

The assessment location will generally be one of the above, or similarly named – select the closest match or ‘Other’ if none of them fit.

Patient Type

This is a new data item for v9. Record the type each patient presentation is grouped within.

Note:

• multiple selections can be made if more than one option fits

The purpose of this data item is to capture the volume of patients being seen by AOS, divided into these Patient groups:

• Type I (1) - all patients in whom a first diagnosis of cancer is suspected in the emergency setting
• Type II (2) - patient with known cancer who present as an emergency with acute complications of non-surgical treatment, including Systemic Anti-Cancer Therapy (SACT) or radiotherapy
• Type IIIa (3a) - patients with known cancer and are acutely ill because of the disease itself; this group represent the largest proportion of emergency patients and often present with complex issues including comorbidity, progressive cancer and end of life care (EOL) needs
• Type IIIb (3b) - patient with known cancer and are acutely ill because of comorbidity

See below table for mapping between the data items values that the Type I, II and III patient groups.

Acute Oncology Patient Type and Patient Group Mapping

The Comorbidity Complication and Other patients will help establish the volume of patients who are assessed by AOS but do not actually have a specific cancer related issue at that time.

Interpretation

New Presentation:

• this option is relevant for patients who have never had a cancer diagnosis before and who are diagnosed for the first time after an emergency attendance
• because these patients will not have an existing cancer record, an eligible cancer record will need to be created to enable the reporting of the AO data items
• it is acknowledged there will be some AOS activity that cannot be reported via the COSD because the patient is confirmed with a non-cancer diagnosis

Treatment Complication:

• this option is relevant for patients who have received or are receiving Cancer treatment and have become poorly as a consequence
• this could include patients who have an acute or chronic response to treatment, for example patients who have an AO episode for acute SACT or Radiotherapy reactions or have a chronic condition caused by historic cancer treatment which has left them with directly related health complications

Suspected or Confirmed Neutropenic Sepsis:

• although this could come under Treatment Complication it has been split out to capture any patients with an AO episode that started off as a suspected or concluded as a confirmed case of Neutropenic Sepsis/Febrile Neutropenia
• these data are intended to establish a national picture of the number of suspected NS cases in England

Cancer Complication:

• this option is relevant for patients who have become poorly because of their cancer rather than because of the treatment they are receiving
• these patients could have a current diagnosed cancer and are on active treatment or monitoring or patients who have an historic diagnosis

Cancer Recurrence/Progression (Local/Regional): 

• this option is relevant for patients who have become poorly because their current or historic cancer has progressed either locally or regionally
• for example the cancer has returned in the same location as the original diagnosis or has spread to regional lymph nodes

Cancer Recurrence/Progression (Distant)

• this option is relevant for patients who have become poorly because their current or historic cancer has spread to a distant part of their body
• for example the cancer has spread to distant lymph nodes or to the liver

Cancer Transformation:

• this option is relevant for patients who have had
• for example a known haematological cancer that has transformed into another disease type

Suspected or Confirmed MSCC:

• this option is for patients who are suspected of having Metastatic Spinal Cord Compression (MSCC) and should be recorded as such regardless of whether the diagnosis is confirmed
• MSCC patients could also be New Diagnosis, Cancer Progression or Recurrence but it has been separated out so national analysis can be carried out on the number of MSCC patients

Comorbidity Complications:

• this option is for patients who present with Comorbidity complications, for example heart disease or diabetes and receive an AOS assessment
• it is important to gather data on these patients in order to assess the volume of AOS activity

Other:

• this option covers patients who have an emergency presentation for a reason unrelated to their diagnosed cancer, treatment or comorbidity
• for example a broken bone – this data is not essential but would again help identify the volume of AOS activity

Introduction to options 5, 6 and 7 above: recurrences, progressions and transformations

Cancer Complication includes patients who are on a non-Primary Pathway as per the description included in this COSD v9 User Guidance. To enable more comprehensive levels of analysis on the types of patients seen by AOS, see below for details on how to ensure the patient records are created to enable the reporting of the AO data in COSD.

If the patient is on:

• a ‘Recurrence Pathway’ as per the Guidance, and your Cancer Services will be overseeing the care of the patient, a new cancer referral will need to be created to enable the reporting of the AO and other relevant COSD data items
• a ‘Progression Pathway’ as per the Guidance and your Cancer Services will be overseeing the care of the patient, a new record will need to be created to tie in the AO and other relevant COSD data items
• a ‘Transformation Pathway’ as per the Guidance and your Cancer Services will be overseeing the care of the patient, a new record will need to be created to tie in the AO and other relevant COSD data items
• any of the above non-Primary Pathways and the patient is being referred on to another Cancer Care Provider for all of their care, the AO episode details should be forwarded onto this Provider for inclusion in their submission to COSD

Outcome

This is a new data item for v9. Record the outcome of the acute oncology episode.

This information will generally be captured in the local PAS or Emergency Department system (if separate) or maybe in a dedicated AOS system.

These data will help with admission avoidance and length of stay calculations and focuses on the outcome of the interaction, rather than the outcome on the patient’s overall condition. Patient Died has been included to cover all potential outcomes.

Interpretation

Not Admitted:

• this option would be selected if the patient was not admitted to hospital and was sent to their usual place of residence after being assessed by the AOS - this activity would usually be counted as ‘Admission Avoidance’

Admitted:

• this option would be selected if the patient was assessed by AOS and admitted either on their recommendation or in consultation with relevant Acute Medicine staff

Remained Admitted:

• this option would be selected if the patient was already an admitted patient before their AOS assessment and continued as an admitted patient after assessment with no recommendation by AOS to be discharged

Discharged:

• this option would be selected if the patient was already an admitted patient before their AOS assessment and AOS recommended the patient was discharged after assessment
• this activity would generally be used in the Length of Stay calculations

Patient Died:

• this option would be selected if the patient died during their AO episode whilst onsite at the Hospital, regardless of whether they had been an admitted patient or not

Other:

• this option covers outcomes not listed in the above