Introduction
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 NKCA interactive dashboard is the product of a year-long development process that took place during 2024, following a successful pilot project by the National Lung Cancer Audit (NLCA).
The dashboard is subject to ongoing iterative development and we therefore welcome suggestions and feedback, which can help guide changes made in future releases.
A second phase of development is planned for 2025, during which we will seek feedback more broadly, consulting with a wide range of stakeholders, including PPI representatives, to ensure the dashboards continue to meet the needs of our end users.
Overview of dashboards
The data quality metrics in this report provide an overview of the quality of key data items for 27,616 people diagnosed with kidney cancer in England between 1st July 2021 and 30th June 2024.
The performance indicators (first treatment within 31 days of decision to treat / first treatment within 62 days of urgent referral) in this report include 14,587 people diagnosed with kidney cancer in England between 1st July 2021 – 31st December 2023 who received treatment.
Data sources
In England, NATCAN receives information from the National Cancer Registration and Analysis Service (NCRAS), part of the National Disease Registration Service (NDRS), NHS England. NDRS collects patient-level data from all NHS acute providers on people with cancer using a range of national data-feeds. This includes the Cancer Registration datasets and the Cancer Outcomes and Services Dataset (COSD). COSD data are submitted to the NDRS monthly via Multidisciplinary Team electronic data collection systems. Clinical sign-off of data submitted to NDRS is not mandated in England. The information held in the registration dataset is compiled from a number of sources.
For this quarterly report, the NKCA utilised data from:
- Rapid Cancer Registration Dataset (RCRD)
- Cancer Waiting Times (CWT)
- Hospital Episode Statistics Admitted Patient Care (HES APC)
- Radiotherapy Data Set (RTDS)
- Systemic Anti-Cancer Therapy (SACT)
- 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. It is also worth noting that RCRD does not have complete coverage of all patients diagnosed with kidney cancer in England during the reporting period. To access more information about the RCRD click here. RCRD and COSD were received by NATCAN in November 2024. The RCRD received contained patient data submitted to NDRS by English NHS trusts for people diagnosed between 1st January 2018 and 31st August 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 July and August 2024 so that we could align with the quarters by calendar year (Q1 = Jan-Mar; Q2 = Apr-Jun; Q3 = Jul-Sep; Q4 = Oct-Dec).
Some of the COSD data items received (e.g. lesion size and TNM) contained patient data submitted to NDRS by English NHS trusts for people diagnosed between 1st January 2018 and 30th June 2023. For the data quality metrics that use these COSD data items, we have included the latest 24 months of data in this quarterly report.
For the performance indicators (first treatment within 31 days of decision to treat / first treatment within 62 days of urgent referral), the NKCA utilised data from RCRD and linked datasets. CWT dataset was used to identify urgent referral, decision to treat date, factor in wait time adjustments and to identify people whose first treatment was active surveillance or palliation. HES APC dataset was used to identify kidney cancer surgery, radiotherapy and systemic anti-cancer therapy. RTDS was also used to identify radiotherapy and 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 62 days of follow up from urgent referral. There is also currently a lag in receipt of required Hospital Episodes Statistics Admitted Patient Care (HES APC) data and Systemic Anti-Cancer Therapy (SACT) data compared the main cancer registration dataset (RCRD).
Why do we report data completeness?
We report 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.
How did we select our performance indicators?
- Percentage of people who receive treatment for kidney cancer that receive their first treatment within 31 days of decision to treat
- Percentage of people who receive treatment for kidney cancer that receive their first treatment within 62 days of an urgent referral
These were 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 and completeness 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.
How have we chosen these specific data items to focus on?
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.
A data issue has been identified by NDRS in the Rapid Cancer Registration Data (RCRD) used in the NKCA January 2025 dashboards, because of a temporary issue with the way HES and death certificate data are used to construct the dataset. This has resulted in around 1% of tumours missing from the dataset across all tumour types. It has had a larger impact on more fatal cancers and older patients, and therefore varies between cancer sites. NDRS are working to correct this issue for future releases of RCRD.
Last updated: 9 January 2025, 9:43am