National Audit of Breast Cancer in Older Patients (NABCOP) [ Insert name of presenter ]

1. National Audit of Breast Cancer in Older Patients (NABCOP) [Insert name of presenter] [Insert name of event] [Insert name of NHS organisation] 2019 Annual report www.nabcop.org.uk @NABCOP_news

2. Background • Aim: To audit breast cancer care received by women aged 70+yrs in NHS organisations in England and Wales • Compare care received with women aged 50–69 years • NABCOP is a collaboration between ABS and RCSEng • Commissioned by HQIP as part of the National Clinical Audit Patient Outcomes Programme (NCAPOP) • Started in April 2016 • Using existing national datasets provided by NCRAS (England) and CANISC (Wales) • No audit-specific data entry required by NHS organisations @NABCOP_news

3. Year 3 (2019) Describes patterns of care between women aged 50-69yrs and 70+ years, in the following groups of breast cancer: • DCIS • Early invasive breast cancer (stage 1-3A) • Metastatic breast cancer (Stage 4) This includes findings from the English Cancer Patient Experience (CPES) survey for patients diagnosed in 2015. https://www.nabcop.org.uk/reports/nabcop-2019-annual-report/

4. Women included in the 2019 Annual Report Age 50+ years, diagnosed with breast cancer between 01 Jan 2014 and 31 Dec 2017 in England and Wales Women with only one tumour, diagnosed with DCIS or invasive disease N = 147,162 • NHS organisation participation: • English NHS trusts = 124 • Welsh local health boards = 6 Invasive BC N = 131,495 (89%) DCIS BC N = 15,667 (11%) Metastatic*** BC N = 6,550 (5%) Unknown stage N = 10,383 (8%) Early invasive* BC N = 109,018 (83%) Advanced non-metastatic** BC N = 5,544 (4%) * Early invasive = Stage 1-3A ** Advanced non-metastatic = Stage 3B, 3C *** Metastatic = Stage 4 @NABCOP_news

5. Distribution of disease severity (stage) by screen detected cancer status and age * in women diagnosed between 2014 – 2017

6. Availability of core data items: for women diagnosed in England in 2017

7. [insert NHS organisation name] Women diagnosed in 2017 Routes to diagnosis

8. CNS contact reported as “Yes”: for women diagnosed in 2017

9. Ductal carcinoma in situ (DCIS)* • Overall rate of surgery decreased with age • 50–69 years: 93%, 70+ years: 81% • Wider variation in the rate of surgery in women aged 70+ years in England and Wales, compared to women aged 50 - 69 years * in women diagnosed between 2014 – 2017

10. Early invasive breast cancer (EIBC): surgery* • Overall rate of surgery decreased with age: 50–69 years: 95%, 70+ years: 74% • Women aged 70+ years were more likely to receive surgery for ER-negative compared to ER-positive breast cancer, irrespective of measurement of fitness * in women diagnosed between 2014 – 2017

11. ER-negative ER-positive Risk-adjusted % of women aged 70+ years receiving surgery for early invasive breast cancer (EIBC), by diagnosing NHS organisation and ER status [insert the name of your NHS organisation] @NABCOP_news

12. Early invasive breast cancer (EIBC): radiotherapy (RT) * • Overall, 89% of women received RT post-BCS: • 91% in 50-69 years, 84% in 70+ years • Overall, 64% of women received RT post-Mxfor high risk EIBC: • 67% in 50-69 years, 60% in 70+ years * in women diagnosed between 2014 – 2017

13. Mastectomy BCS Observed % of women with EIBC receiving RT after surgery, by diagnosing NHS organisation, age at diagnosis and type of surgery [insert the name of your NHS organisation] @NABCOP_news

14. Early invasive breast cancer (EIBC): chemotherapy (CT) * • In women with ER-negative, HER2-negative, N+ EIBC 53% had adjuvant CT • 73% in 50-69 years, 30% in 70+ years • In women with HER2-positive EIBC who received surgery, 59% had CT and trastuzumab: • 69% in 50-69 years, 36% in 70+ years * in women diagnosed between 2014 – 2017

15. 50 – 69 years 70+ years Risk-adjusted % of women with HER2-positive EIBC receiving adjuvant chemotherapy + trastuzumab, by diagnosing NHS organisation and age at diagnosis [insert the name of your NHS organisation] @NABCOP_news

16. Metastatic breast cancer* • 5% of women had metastatic BC at presentation • 3% in 50-69 years, 7% in 70+ years • ER-status was unknown for: • 23% in 50-69 years, 28% in 70+ years • Women aged 70+ years were less likely to receive CT irrespective of fitness or ER status • 59% of women aged 50-69 years, 24% * in women diagnosed between 2014 – 2017

17. 50 – 69 years 70+ years Risk-adjusted % of women with newly-diagnosed metastatic breast cancer receiving chemotherapy, by age at diagnosis [insert the name of your NHS organisation] @NABCOP_news

18. What do patients say about their BC care? - Cancer patient experience survey (CPES)* * Results available for women diagnosed in 2015 • CNS involvement • 95% were given the name of a CNS who would support them through treatment • 78% said that it had been ‘quite’ or ‘very’ easy to contact their CNS • DCIS • 81% of respondents with ≥1 treatment options, reported that their options were explained to them completely • Among women who had RT: 60% completely agreed that they were given enough information that their treatment was working (58% in 50-69 years, 77% in 70+ years) • EIBC : on a scale of 0 (very poor) to 10 (very good), 96% of respondents gave their overall care a rating of ≥ 7 • Among women who did not have surgery: this care rating was recorded in 96% of women aged 50–69 years and 88% of women aged 70+ years. • Among women who had radiotherapy: 53% completely agreed that they were given enough information that their treatment was working • Among women who had chemotherapy: 52% completely agreed that they were given enough information that their treatment was working

19. Proposal: NABCOP fitness assessment To identify frailty, cognitive impairment and evaluate a patient’s overall health To be able to record the results of these assessments in a reproducible manner This is valuable towards ensuring women are not treated based on chronological age alone, and for improving methods of comparison of provision of care for older patients.

20. Fitness assessment for older patients in breast clinic • Do you have any severe* cardiorespiratory disease? Yes / No • * severe = less than ordinary physical activity or rest causes tiredness, palpitations or shortness of breath • Do you have any other significant malignancy? Yes / No Majority of the pilot sites found the assessment useful towards decision making/ treatment planning.

21. Local summary of NABCOP data • Our data completion for core NABCOP data items : • In comparison to the national average, our rate of: • Surgery for DCIS is higher / lower / comparable (delete as appropriate) • Surgery for ER-positive EIBC is higher / lower / comparable (delete as appropriate) • Radiotherapy post-BCS for EIBC is higher / lower / comparable (delete as appropriate) • Chemotherapy + trastuzumab for women with HER2-positive EIBC is higher / lower / comparable (delete as appropriate) @NABCOP_news

22. Local plan of action for NABCOP • To improve data completion: [insert plan] • To audit reasons behind variation for [insert type of treatment of interest] in women with [insert breast cancer group] • Plan for re-audit: • Time frame: [ insert ] • Methods: [ insert ] • Aim: [ insert ] • Responsible consultant: [ insert name ] @NABCOP_news

23. w: www.nabcop.org.uk e: nabcop@rcseng.ac.uk : @NABCOP_news