Cancer

CDRC recommends running the following reports on an annual basis, early in Q4. Please click here for information on how to add these reports to your Automated Reports (Batch Searches).

Report Name	Report Location	Report Returns	Action
? Cancer Coding 2.11 – Cancer care review but not on cancer register	CDRC Quality > Cancer	Patients with a cancer care review but no QoF cancer code.	Review record and add cancer code if appropriate.
? Cancer Coding 2.12 – Has cancer code but not ‘new’ code	CDRC Quality > Cancer	Patients with a cancer code but no ‘new’ cancer code.	Review record and change episodicity of code if appropriate.
? Cancer Coding 2.13 – Has possible cancer code but no QoF cancer code	CDRC Quality > Cancer	Patients with a possible cancer code but no QoF cancer code.	Use the QoF and contracting template to review codes and add a QoF cancer code if appropriate.
? Cancer Coding 2.14 – Has chemo or radiotherapy but no QoF cancer code	CDRC Quality > Cancer	Patients who have had chemo- or radiotherapy but do not have a QoF cancer code.	Review record and add cancer code if appropriate.
? Cancer Coding 2.15 – Has breast cancer hormones but no QoF cancer code	CDRC Quality > Cancer	Patients who have received breast cancer hormone treatment but don’t have a QoF cancer code.	Review record and add cancer code if appropriate.

CDRC recommends running the following reports on a monthly basis.

Report Name	Report Location	Report Returns	Action
? Cancer Management 3.1 – Needs Cancer Care Review (diagnosis >7m ago)	CDRC Quality > Cancer	Patients who need a cancer care review.	Contact patient to arrange cancer care review using the Cancer Care template.
? Cancer Management 3.2 – Needs Cancer Support Information	CDRC Quality > Cancer	Patients who need cancer support information.	Post or send electronically the Cancer Support Information letter.

How to Access

In the lower left hand corner use the search bar, type in ‘Cancer Screening Summary – CDRC’ and select the following template:

Alternatively, press F12 and search for ‘Cancer Screening Summary – CDRC’, this will return the aforementioned template.

Cancer Screening Summary Template

The Screening Summary template displays the most recent information regarding the major screening programmes with links to more detailed information. 

It is possible to quickly record a verbal invitation using this template. 

How to Access

In the lower left hand corner use the search bar, type in ‘Cancer Care CDRC’ and select the following template:

Alternatively, press F12 and search for ‘Cancer Care CDRC’, this will return the aforementioned template.

Cancer Care CDRC Template

The Home Page provides an overview of patient’s cancer and main forms of treatment.   

A new cancer diagnosis can be added using the New Cancer Diagnosis button giving the user the option to record the diagnosis as a problem, summary or simple Read code entry. 

The most recent cancer care review code is displayed along with the current QoF performance status. Previous and current cancer treatment is shown. 

A link is available to create a cancer support services letter to send or give to the patient. 

The Care Review Page facilitates a cancer care review. There is a link to the standard CDRC lifestyle issues template (weight, alcohol, smoking etc.). 

The Professionals Page shows professional relationships. The left panel shows professionals most likely to be related to cancer care e.g. specialist nurse, oncologist, consultant, district nurse, practice nurse. The right panel shows other professional relationships. 

The Familial Cancer Page provides information on familial cancer, links to the Northern Genetics website and a link to the CDRC FHx Breast Cancer template 

The Resources Page displays links to useful information for clinicians and patients. 

• Cancer Register – CAN001
• Cancer Care Review – CAN004
• Cancer Support Information – CAN005

Cancer Register – CAN001

The value of QoF cancer payments is dependent upon the unit’s cancer prevalence.  It is important to ensure all relevant patients are included on the cancer register.  The register is defined as all patients with a code from the CAN code cluster (which must be have ‘new’ episodisity) on or after 1st April 2003. The CAN code cluster does not include non-melanoma skin cancers 

Steps To Improve Performance 

1. One-off steps
   1. Add the CAN code cluster to the Automatic Episodicity list, so new cancer diagnoses are automatically recorded as ‘new’ episodes 
2. Ongoing steps
   1. Use the Data Entry – Cancer Template to enter cancer diagnoses – this will ensure that QoF codes are used 
   2. Run the following searches (and add them to a batch search to run every 6-12 months) 

Search Name	Search Location	Action
? Cancer 2.11 Coding – Cancer care review but not on cancer register	CDRC Quality > Cancer	Review record and see if the patient has an uncoded cancer (or wrong episodicity)
? Cancer 2.12 Coding – Has cancer code but not ‘new’ code	CDRC Quality > Cancer	Review record and see cancer if episodicity need to be set to ‘new’
? Cancer 2.13 Coding – Has possible cancer code but no QoF cancer code	CDRC Quality > Cancer	Review record to see if a cancer needs to be recoded using a QoF code.
? Cancer 2.14 Coding – Had chemo or radiotherapy but no QoF cancer code	CDRC Quality > Cancer	Review record to see if chemo or radiotherapy was for cancer (not skin SCC/BCC)
? Cancer 2.15 Coding – Had breast cancer hormones but no QoF cancer code	CDRC Quality > Cancer	Review record to see if breast cancer hormone treatment was for breast cancer

1. Activate the opt-in resources (see below) to provide real-time prompts to improve coding: 

Protocol Name	Description
Non-QoF code	Will trigger an alert if a code which suggest cancer but is not a QoF cancer code is added e.g. Adenocarcinoma
Equivocal BCC and SCC codes	Will trigger an alert if equivocal BCC or SCC codes are added. These codes are usually added intending to refer to non-melanoma skin cancer (which are not in the QoF cancer register) but can sometimes be added for systemic cancer such as squamous cell carcinoma of the oesophagus

Cancer Care Review – CAN004

Cancer Care Review for patients on the cancer register within 12m of diagnosis for those diagnosed in the last 24m. 

Conducting Cancer Care Review 

Patients should be offered a cancer care review in the 12 months after diagnosis, ideally at around 7-9 months.  The cancer care review can be conducted using the cancer care review page of the Cancer Care Template.  To identify patients for the review use a scheduled task at diagnosis or this report: 

Steps To Improve Performance 

• Run the following search (and add it to a batch search to run every month) 

Search Name	Search Location	Action
? Cancer 3.1 Management – Needs Cancer Care Review (diagnosis >7m ago)	CDRC Quality > Cancer	Review record and offer CCR as appropriate or exception report

3. QoF Review Reports. Towards the end of the financial year review the patients in the ‘not achieved’ report in the CDRC Contracting > QoF folder:  Cancer CAN004 Review within 12m of diagnosis 1.2 Not Achieved (excluding patients already excepted) 

Issue	Possible remedy
Patient does not wish to have cancer care review	Code Excepted from cancer quality indicators: Informed dissent
Patient not suitable for cancer care review e.g. terminally ill	Code Excepted from cancer quality indicators: Patient unsuitable
Patient’s cancer was coded with a date later than the date the diagnosis was clear, so should not be included in this QoF year.  This would be a diagnosis more than 2 years before the end of the current financial year or before 1/1/2021	Mark the incorrectly dated code(s) in error and re-add the code with the correct date
Patient has had duplicate ‘new’ entries for the same cancer (each ‘new’ code resets the QoF clock)	Reset the episodicity of the cancer code to ‘ongoing’ OR mark the duplicate code ‘in error’ if appropriate

Cancer Support Information – CAN005

Cancer support information for patients on the cancer register within 3m of diagnosis for those diagnosed in the last 12m. 

Providing Cancer Support information 

Patients should have the cancer support information sent/given to them at diagnosis.  This can be achieved by creating the letter from the Cancer Care Template (see above) or by sending a letter to patients in this report:  

Some template letters are available. Letters for other areas can be added on request. 

Steps To Improve Performance 

• Run the following search (and add it to a batch search to run every month): 

Search Name	Search Location	Action
? Cancer 3.2 Management – Needs Cancer Support Information	CDRC Quality > Cancer	Review record and offer cancer support information as appropriate

• QoF Review Reports. Towards the end of the financial year review the patients in the ‘not achieved’ report in the CDRC Contracting > QoF folder: Cancer CAN005 Support info within 3m of diagnosis 1.2 Not Achieved EOY (excluding patients already excepted) 

Issue	Possible remedy
Patient does not wish to have cancer care review	Code Excepted from cancer quality indicators: Informed dissent
Patient not suitable for cancer care review e.g. terminally ill	Code Excepted from cancer quality indicators: Patient unsuitable
Patient’s cancer was coded with a date later than the date the diagnosis was clear, so should not be included in this QoF year.  This would be a diagnosis more than 2 years before the end of the current financial year or before 1/4/2021	Mark the incorrectly dated code(s) in error and re-add the code with the correct date
Patient has had duplicate ‘new’ entries for the same cancer (each ‘new’ code resets the QoF clock)	Reset the episodicity of the cancer code to ‘ongoing’ OR mark the duplicate code ‘in error’ if appropriate