Core – Treatment

The initial record is completed up to the first treatment, but all subsequent treatments are also required. Treatments are also reported for cases covered by Cancer Waiting Times although some additional details are included in COSD in both generic core and site specific sections.

It is possible that some legacy data may not have all the required mandatory fields. The recommendation is for Trusts to update their data to meet the new requirements and improve/enrich their data submissions, or not upload the legacy data items in the new record (if that data is not available).

May be multiple occurrences per record (0..*)

Start of Section - Consultant (treatment)

May one occurrences per Core - Treatment (0..1)

End of section - Consultant (treatment)

The following data item has been retired in v10 and replaced with CR9080:

• CR0750 Discharge Destination (Hospital Provider Spell), due to a change in the data dictionary

Adjunctive Therapy

Adjunctive therapy is therapy given in addition to the main therapy to maximize its effectiveness. This field allows for the accurate recording of these to determine if adjunctive therapy was adjuvant (after the main therapy) or neo-adjuvant (before the main therapy) or not applicable.

Cancer Treatment Intent

The original intention of the cancer treatment provided during a Cancer Care Spell.

Notes:

• ‘Disease Modification’ is drug specific
• ‘Diagnostic’ and ‘Staging’ are surgery specific

Important note:

• the next 3 data items are mandatory and will improve the data quality and ascertainment of treatment records submitted

Treatment Start Date (Cancer)

This is a mandatory data item. This is the Start Date of the first, second or subsequent cancer treatment given to a patient who is receiving care for a cancer condition. Applicable to all registered cases.

Cancer Treatment Modality (Registration)

This is a mandatory data item. Applicable for active and non-active treatments, and to record where a patient declines treatment. Applies to all treatments at all stages in the patient pathway, including both primary cancer and non primary pathways.

Note:

• 05 – Teletherapy (Beam Radiation excluding Proton Therapy) has been updated to External Beam Radiotherapy (excluding Proton Therapy) to mirror current clinical terminology

Organisation Site Identifier (of Provider Cancer Treatment Start Date)

This is a mandatory data item. This is the ‘Organisation Identifier’ of the organisation site where the treatment took place.

Important notes:

• the next 2 data items are now a multiple selection group and are mandatory within the group
• there may be one occurrence per Core – Treatment Section

Professional Registration Issuer Code – Consultant (Treatment)

This is the ‘Consultant Core (Treatment)’ and is a code which identifies the professional registration body for the consultant or health care professional responsible for the treatment of the patient.

Professional Registration Entry Identifier – Consultant (Treatment)

This is the registration identifier allocated by a Professional Registration Body for the consultant or health care professional who is responsible for the treatment of the patient.

End of Treatment Summary Date

Record the date the End of Treatment Summary was completed at the end of each phase of acute (secondary care) treatment(s) or at the end of a sequence of treatments and sent to the patient and/or the GP. It is for local determination when in the pathway to provide the End of Treatment Summary(s).

Notes:

• this is no longer a multiple repeating data item, only one EOTS date is required per treatment record
• this is now a ‘required’ data item, previously ‘optional’

Additional notes to help with data recording:

• the End of Treatment Summary is ‘complete’ when it has been shared with the person and/or their GP
• include the dates of End of Treatment Summaries where:
  • a patient is offered but doesn’t want a copy, but it is sent to their GP
  • a patient has a copy, but they requested that it is not sent to their GP
• there should be at least one End of Treatment Summary relating to primary treatment
• the End of Treatment Summary is different from a discharge summary due to the incorporation of specific information and advice for the patient and GP (see below)
• it should be produced promptly after the treatment
• due to many patients having multiple treatments, it may be preferable to label the document as ‘Treatment Summary’ or ’Radiotherapy Treatment Summary’ to avoid confusion for patients
• the document has to be named ‘End of Treatment Summary’ in COSD to avoid confusion with other documents such as the Treatment Plan
• check your cancer system requirements regarding data entry, as you may need to record the End of Treatment Summary in more than one place to ensure data is submitted to COSD.

Information to support implementation of End of Treatment Summaries:

• Macmillan have published a Cancer Support Treatment Summary How To guide, which you can access by using this link
• you can access a Macmillan Cancer Support e-learning module on End of Treatment Summaries using this link - Opens in a new window - requires login
• an End of Treatment Summary plan is a quality standard in the NICE guidance for Haematological Cancers, and it is recommended by NHS England for all cancer types as part of Personalised Care
• the content of an ‘End of Treatment Summary’ will normally follow a locally agreed template, incorporating key items that will support self-management, as well as guiding GP practices with their Cancer Care Reviews. Contents include:
  • a summary of diagnosis and treatment
  • schedule of surveillance scans and tests
  • potential markers of recurrence/secondary cancers and information on what to do in these circumstances
  • information on likely side-effects of treatment and how best to manage these, including those that might appear after some months/years
  • key contact point for rapid re-entry if recurrence markers are experienced or if serious side effects become apparent
  • referrals made to other services, for example rehabilitation, mental health care
  • prompts for GP actions
  • lifestyle advice and self-management guidance that the person has been given or signposted to, including details of local support groups and psychosocial support, such as complementary therapies, physical activity, financial support and employment advice

Note:

• NHS England is not responsible for the content of external websites, all weblinks are current as of 25th April 2023

Discharge Date (Hospital Provider Spell)

The date a patient was discharged from a hospital provider spell.

Destination of Discharge (Hospital Provider Spell)

This is a new data item in v10. This records the destination of a patient on completion of the hospital provider spell. It can also indicate that the patient died.

This section is a child of ‘Core – Treatment' and has changed to carry only the surgery details.

It is possible that some legacy data may not have all the required mandatory fields. The recommendation is for Trusts to update their data to meet the new requirements and improve/enrich their data submissions, or not upload the legacy data items in the new record (if that data is not available).

May be up to one occurrence per Core - Treatment (0..1)

Start of repeating section - 'Consultant Code (Surgeon)'

End of repeating section - 'Consultant Code (Surgeon)'

Start of repeating item - 'Procedure (OPCS)'

End of repeating item - 'Procedure (OPCS)'

Start of repeating item - 'Procedure (SNOMED CT)'

End of repeating item - 'Procedure (SNOMED CT)'

Procedure Date

This is a mandatory data item and records the date the surgical procedure was carried out.

Surgical Admission Type

This records the type of surgical admission.

Important notes:

• the next 2 data items are within a multiple selection group and are mandatory within the group
• there may be one occurrence per ‘CORE – Treatment - Surgery’

Professional Registration Issuer Code – Consultant (Surgeon)

This is a code which identifies the professional registration body for the consultant or health care professional who is responsible for the treatment of the patient. If he/she is part of a surgical team, add all consultant surgeons responsible for the procedure.

Professional Registration Entry Identifier - Consultant (Surgeon)

This is the registration identifier allocated by a Professional Registration Body for the consultant or health care professional who is responsible for the treatment of the patient. If he/she is part of a surgical team, add all consultant surgeons responsible for the procedure.

Primary Procedure (OPCS)

This is the OPCS Classification of Interventions and Procedures code which is used to identify the primary procedure carried out.

Primary Procedure (SNOMED CT)

The primary procedure is the main procedure carried out using SNOMED CT. This may be recorded in addition to ‘Primary Procedure (OPCS)’.

Notes:

• any Trust who can submit data in SNOMED CT, must now do so
• refer to the ‘how to find a SNOMED CT procedure' section

Procedure (OPCS)

This is a procedure(s) other than the ‘Primary Procedure (OPCS)’, carried out and recorded for CDS or Hospital Episode Statistics purposes (more than one code can be recorded).

Procedure (SNOMED CT)

This is a procedure(s) other than the ‘Primary Procedure’, carried out and recorded for CDS or Hospital Episode Statistics purposes (more than one code can be recorded). This may be recorded in addition to ‘Procedure (OPCS)’.

Notes:

• any Trust who can submit data in SNOMED CT, must now do so
• refer to the ‘how to find a SNOMED CT procedure' section

Unplanned Return To Theatre Indicator

Whether or not the patient required a second (unplanned) operation during the same admission as the primary procedure.

The proposed collection of this data item is:

• if it is a planned primary procedure, select N (as this is not an unplanned return to theatre)
• if this is an unplanned return to theatre (within the same admission/discharge period), create a completely new surgery treatment record for this and then select Y
• the admission and discharge dates for both however would be the same
• the procedure date, OPCS procedures and possibly surgeon(s) may be different

ASA Score

The ASA physical status classification system is a system for assessing the fitness of patients before surgery. You would expect to find this information in the pre-operative notes or the Anaesthetist review section.

Surgical Access Type

Approach to surgery (laparoscopic, thoracoscopic, open, robotic or converted). Record the access used to perform the operation. Recording the surgical access is standard clinical practice and should be obtained from the operational notes.

This section has been removed on the advice of the COSD Governance Board, following a thorough 6-month clinical review.