NKCA Quarterly Clinical Performance Indicator Report April 2021 to March 2024 – Published October 2024

The purpose of the National Kidney Cancer Audit (NKCA) is to evaluate the patterns of care and outcomes for people diagnosed with kidney cancer in England and Wales, and to support services to improve the quality of care for these patients.

The latest NKCA quarterly report can be accessed here

Patient cohort / reporting periods

This quarterly report provides an overview of the quality of key data items for 27,908 people diagnosed with kidney cancer in England between 1st April 2021 and 31st March 2024.

The performance indicator (first treatment within 31 days of decision to treat) in this report includes 16,904 people diagnosed with kidney cancer in England between 1st April 2021 and 31st December 2023 who received treatment.

For this quarterly report, the National Kidney Cancer Audit (NKCA) utilised data from the Rapid Cancer Registration Dataset (RCRD) and Cancer Outcomes and Services Dataset (COSD). While RCRD is compiled mainly from COSD records, the speed of production means that the range of data items is limited and several standard data items in the complete National Cancer Registration Dataset (NCRD) are unavailable. We therefore also report data completeness for a few select items from the COSD that are not reported in the RCRD, but that will be required to develop and report key performance indicators. RCRD and COSD were received by the National Cancer Audit Collaborating Centre (NATCAN) in August 2024. The RCRD received contained patient data submitted to National Disease Registration Service (NDRS) by English NHS trusts for people diagnosed between 1st January 2018 and 31st May 2024.

For the data quality metrics that use RCRD, we have included the three most recent years of data in this quarterly report except we have not included April or May 2024 so that we could align with the year’s natural quarters (Q1 = Jan-Mar; Q2 = Apr-Jun; Q3 = Jul-Sep; Q4 = Oct-Dec). Some of the COSD data items received contained patient data submitted to NDRS by English NHS trusts for people diagnosed between 1st January 2018 and 28th February 2023. For the data quality metrics that use these COSD data items, we have included the latest 21 months of data in this quarterly report except we have not included January or February 2023 so that we could align with the year’s natural quarters (Q1 = Jan-Mar; Q2 = Apr-Jun; Q3 = Jul-Sep; Q4 = Oct-Dec).

For the performance indicator (first treatment within 31 days of decision to treat), the NKCA utilised data from RCRD and linked datasets. Cancer Waiting Times (CWT) dataset was used to identify decision to treat date, factor in wait time adjustments and to identify people whose first treatment was active surveillance. Hospital Episode Statistics Admitted Patient Care (HES APC) dataset was used to identify kidney cancer surgery, radiotherapy and systemic anti-cancer therapy. Radiotherapy Data Set (RTDS) was also used to identify radiotherapy and Systemic Anti-Cancer Therapy (SACT) dataset was used to identify systemic anti-cancer therapy. The most recent people included were those who were diagnosed on 31st December 2023 due to the requirement of 31 days of follow up from decision to treat date and a lag in receipt of required HES APC data compared with the main cancer registration dataset (RCRD).

This is the third quarterly report published by the NKCA team. The first two NKCA quarterly reports included data quality metrics only.

We initially focused on data completeness as this aspect of data quality underpins what we can reliably and robustly report as an audit. We encourage all provider teams to review their data completeness and make improvements as this will increase the number of people we can include in analyses and increase the range of analyses we can conduct. By continuing to report on data completeness, we are aiming to shine a spotlight on areas where improvements are needed.

The first performance indicator we are going to report quarterly is “Percentage of people who receive treatment for kidney cancer that receive their first treatment within 31 days of decision to treat”. This was selected based on methodological development work conducted by the NKCA. The NKCA State of the Nation report indicators are currently challenging to report quarterly due to 1) current limitations of the RCRD such as lag in availability of TNM and lesion size which are used for cohort definition and 2) small numbers at the Trust-level when reporting on a quarterly basis.

Going forward, the team will continue development work, in consultation with stakeholders, to determine which performance indicators are appropriate for quarterly reporting using the RCRD.

The specific data items we report the completeness of were chosen in collaboration with the audit’s clinical and methodological experts.

Clinical nurse specialist was chosen as we would like to better explore the experience of people diagnosed with kidney cancer so improving the completeness of this data item is key.

Ethnicity was chosen as we would like to thoroughly explore inequalities in cancer care which is a priority for NHS England. To enable this, it is important that every patient has ethnicity accurately recorded.

Lesion size was chosen as it is important in kidney cancer for assessing the eligibility of patients for different treatments.

Multidisciplinary team (MDT) first meeting date was chosen as we would like to investigate what proportion of people diagnosed with kidney cancer are discussed at an MDT before undergoing treatment.

Morphology was selected as it could allow us to explore kidney cancer subtypes.

Performance status was chosen as it is important across cancers for assessing the eligibility of patients for different treatments.

TNM, which is stage of disease where “T” represents the local stage, “N” represents the presence of lymph node involvement and “M” represents the presence of metastatic disease, is essential for risk stratifying patients. In kidney cancer TNM is particularly important as knowing whether a patient is stage I-IV does not provide information regarding regional lymph node involvement as well as distant metastatic disease. We are also interested in whether full T stage (T1a, T1b, etc.) is recorded as that is useful for assessing eligibility for different treatments.

It is natural for metric values to vary from quarter to quarter. This might be due to random variation or to changes in hospital activity. The moving average smooths the changes in the sequence of values to a certain extent, and this can help to reveal longer term trends / changes in patterns of data completeness.

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NKCA Quarterly Report, April 2021 to March 2024