Quality and Performance Monitoring
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Since the publication in 2004 of the national document, The Manual for Cancer Services, a further set of measures was developed so that Cancer Registries could be included in the peer review process, alongside cancer service providers. The Registry Measures were originally published in October 2004, with a further amended version released in November 2005.
Peer review for cancer registries is an assessment of the quality of cancer registration in England and Northern Ireland, undertaken by specialist teams of professional peers (colleagues in other registries working in the same discipline) and cancer service user reviewers. The process is overseen and coordinated by a national Quality Director and Quality Manager.
Trent Cancer Registry had a peer-review team visit in April 2007.
The final Peer Review Report and supporting Action Plan was published in July 2007.
In order to closely monitor the quality of the data on the Registry’s database and highlight any potential problem areas, we extract and analyse specific sets of data on a regular basis. Three of the main indicators of quality that we monitor are ascertainment (level of cancer incidence registered), timeliness (how quickly the cases are registered) and the proportion of death certificate only registrations (DCOs) on the database. Regular reports on performance monitoring are presented to the Trent Cancer Registry Steering Group. We are also required to submit performance indicator data for use in the production of a United Kingdom Association of Cancer Registries (UKACR) annual report, along with all other UK cancer registries.
Ascertainment: the level of cancer incidence registered.
The table below shows the number of registrations for all cancers (excluding non-melanoma skin) added to our database for cases diagnosed between 2006 and 2009
Registrations of all malignant cancers (excluding non-melanoma skin), 2006-2009 and %change from previous year (as at 31 March 2011)
| Diagnosis year |
2006 |
2007 |
2008 |
2009 |
| Registrations |
25,762 |
26,526 |
27,319 |
28,221 |
| %change |
2.1 |
3.0 |
3.0 |
3.3 |
Having access to various sources of information has a positive impact on the level of cancer registered by a cancer registry (ascertainment) as well as data quality. Increasing ascertainment, therefore, does not necessarily mean that more cases of cancer are being diagnosed.
The increasing trend as seen in the table is the result of us receiving feeds of pathology data from all laboratories in our area, and more recently, gaining access to Hospital Episode Statistics (HES) and Cancer Waiting Time (CWT) data as new routine sources. We are also now starting to receive data from Multidisciplinary Teams (MDTs).
Timeliness: how quickly cases are registered.
Cancer registries were required to submit registrations for 2009 diagnosed cases to the Office for National Statistics (ONS) by 31st March 2011. This is three months earlier than the previous, longstanding timeliness requirement for registries. Further phased improvements in timeliness have been agreed, with registries being required to submit their registrations to ONS for 2010 diagnosed cases by 31st December 2011.
The chart below shows that our 2009 cases were ready for submission to ONS on time and that our 2010 cases are being processed more quickly.
Death Certificate Only (DCO) rate: the percentage of cases for which the only source of information available was a death notification.
As important information such as an accurate date of diagnosis and tumour morphology may be missing from DCO registrations, these cases are considered to be of potentially lower quality than those made from multiple data sources. Cancer registries therefore aim to have a DCO rate that is as low as possible, actively following up DCO notifications.
The national DCO rate requirement is currently 2% and, with the continued support of our local Cancer Networks and Hospital Trusts, we achieved a rate of 1.9% for our 2009 diagnosed cases.