NAoPri FAQs

NATCAN is all about effective collaboration. Each audit is led by a multidisciplinary team of clinical experts and senior academics to ensure that we ask the right questions about cancer care and treatment, and then use the right methods to answer those questions. NATCAN collaborates closely with all relevant stakeholders to inform the quality improvement (QI) priorities and goals of each audit. That includes professional groups, patient charities and patients.

In this way, the new audits are produced to the same high standard as those that the CEU has run for years, maintaining the standards of excellence the CEU is renowned for.

Clinical audit is a method that healthcare professionals use to look at and improve patient care. They compare how patients are treated, and the outcomes of the care they receive, against set standards and guidelines.

The audits in NATCAN use information on the care received by patients diagnosed with cancer in hospitals across England and Wales. They examine this data in order to make  valid comparisons, and identify improvements where they are needed. The audits which have already been delivered have helped provide a wider understanding of cancer treatments, and created better results for patients. They have also promoted improvement initiatives within NHS cancer services, and identified areas of best practice.

Our audits don’t just examine data about the cancers themselves, they also look at different hospitals and different methods of treatment. That means NATCAN will  focus on how cancer care varies from one hospital to another, with the aim of learning lessons and identifying how we can fight different cancers most effectively.

We will make recommendations to hospitals based on our findings, which will include:

• How patients are diagnosed
• The treatments patients receive such as the use of surgery, radiotherapy and/or chemotherapy
• Outcomes following treatment

To make fair comparisons, we also take account of the facts that all patients are different and have different characteristics. Among the factors we consider are age, whether a patient has pre-existing conditions, and the social or economic circumstances that patients find themselves in. When the data tells us where improvements are needed, NATCAN will lead the drive to deliver change.

We now have our teams in place, and the next steps are to work with professionals and patients to make sure we ask the right questions and the quality improvement goals for each of the new audits are clear. Once the audit questions have been finalised, and the data has been gathered and analysed, we hope to be publishing results beginning in early 2024. We will also prepare short state-of-the-nation reports for each cancer audit, which will each include five specific recommendations. We aim to publish these reports by September 2024.

The NAoPri is delivered by the National Cancer Audit Collaborating Centre (NATCAN), which is part of the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England. The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England and the Welsh Government. The project team works with clinical leads,  Professor Kieran Horgan, Dr. David Dodwell, and Dr. Mark Verrill.The team works closely with their Audit Advisory Committee and Patient and Public Involvement Forum which includes members of professional and patient groups to ensure the audit meets the needs of the primary breast cancer community.  The audit uses data from national registries such as the National Disease Registration Service (NDRS) in England and the Wales Cancer Network (WCN).

The National Audit of Primary Breast Cancer (NAoPri) evaluates the patterns of care and outcomes for people with primary breast cancer  (stages 0 to 3) in NHS hospitals in England and Wales. It builds on the previous National Audit of Breast Cancer in Older Patients (NABCOP) but is expanded to include all ages and genders. The audit uses routinely collected patient data to provide a comprehensive analysis of breast cancer care, , to support NHS services to identify areas of good practice and address areas for improvement.

We use information about patients that is collected by national organisations in England and Wales. These organisations include the National Cancer Registration and Analysis Service (NCRAS) in England and the Wales Cancer Network. They are allowed to collect data on patients diagnosed with cancer, the treatments they receive, and the results of these treatments.

In general terms, what we call the gold standard data is a much richer dataset which gives more detailed information about cancer. It might for example provide data on what particular cancer cells look like under a microscope, which may tell us whether they are likely to be more aggressive.

The rapid data has information about the patient, their diagnosis and their treatments. It has more limited information about the tumour – it only gives us information on staging, which is how medical experts determine the extent to which a cancer has grown and spread. So it can be really useful because it is available so quickly, but we still need the gold standard data to give us a more sophisticated analysis.

No. All the data we use is anonymised, and doesn’t include the names of any individual patients or information such as an NHS number.

Yes, patient involvement is central to everything we do. We are determined to give patients and carers a greater voice at every stage of the process. NATCAN will work with various patient charities, to create a patient forum for each cancer audit. These patients will help ensure that the questions we ask in the audits are appropriate, and that we are reporting information in ways that are useful to the public as well as to health care professionals and hospitals.

Patients and patient charities are involved in all aspects of the delivery of the cancer audits. For each audit, there will be a Patient and Public Involvement Forum to provide insight from a patient perspective on strategic aims and specific audit priorities. This will include shaping the development of each audit’s QI initiatives by ensuring this work is relevant from a patient perspective.

A key activity of the PPI Forums will be to participate actively in the production of patient-focussed audit outputs (including patient and public information, patient summaries of reports, infographics, and design and function of the NATCAN website). This will help guide us on how best to make this information accessible.

The chair of each audit’s PPI Forum will be a member of that audit’s Clinical Reference/Advisory Group to further strengthen the patient voice in the audits.