Site specific - Breast

ICD-10 codes

Note:

• please refer to Appendix A and B for site specific registerable ICD codes for breast cancer patients

Retired data items

The following data item has been retired from v10:

• BR4120 – NPI Score

National Cancer Audit Collaborating Centre (NATCAN)

With the formation of the new National Cancer Audit Collaborating Centre (NATCAN), all previously independent cancer audits have been brought into one organisation. Part of the rationale for this is to reduce the burden of data collection and reporting across the NHS.

As a result, all data moving forward will be from existing data sources. It is important therefore for Trusts to collect all the site specific data items within COSD, as these will form a large part of future analysis by both the National Audit of Primary Breast Cancer (NAoPri) and the National Audit of Metastatic Breast Cancer (NAoMe).

More information about NATCAN can be found via their official website.

For patients with breast cancer who have been diagnosed with recurrence of their cancer, it is important they have a named CNS (whose job plan includes the care of patients with recurrent/metastatic breast cancer) assigned to them and available for support around the time when the recurrence was identified.

The NAoMe would like all MDT coordinators to ensure the corresponding data item on CNS contact is recorded when completing the COSD record for a non-primary cancer pathway.

The CNS data item should be completed using the options available in [CR2050 - Clinical Nurse Specialist Indication Code], which can be found in the ‘CORE - Clinical Nurse Specialist + Risk Factor Assessment’ section.

This data item was recommended by the Breast Expert Advisory Group and continues to be important data within COSD and will be used by the new NAoPri cancer audit.

May be up to one occurrence per record (0..1)

Triple Diagnostic Assessment

If a triple diagnostic assessment was completed, indicate if this was completed for the patient in a single visit, following initial referral?

This is a child of 'Core - Clinical Nurse Specialist + Risk Factor Assessment'. This group of data items are only required for patients aged 70 years and over at diagnosis and will be used by the two new breast cancer audits.

Notes:

• these data only pertain to the risk factors below and not the CNS contact itself
• the CNS contact should be collected within the 'Core' (using CR2050)
  • this requires completion, irrespective if there has been contact made, for all patients, regardless of age

May be up to one occurrence per Clinical Nurse Specialist - Risk Factor Assessment (0..1)

Fitness Assessment Indicator

Indicate if there was a Fitness Assessment carried out on the patient. If yes, please complete the following 6 data items.

Fitness Assessment Date

Record the date the fitness assessment was completed.

Clinical Frailty Scale

Record the point on the Clinical Frailty Scale, as assigned by the appropriate clinician after discussion with the patient.

The chart below explains each frailty measure, using the Clinical Frailty Scale. A text description of the image follows it.

Text description of the Clinical Frailty Scale:

1. Very fit - people who are robust, active, energetic and motivated. These people commonly exercise regularly. They are among the fittest for their age.

2. Well - people who have no active disease symptoms but are less fit than category 1. Often they exercise or are very active occasionally, for example seasonally.
3. Managing well - people whose medical problems are well controlled, but are not regularly active beyond routine walking.
4. Vulnerable - while not dependent on others for daily help, often symptoms limit activities. A common complaint is being "slowed up", and/or being tired during the day.
5. Mildly frail - these people often have more evident slowing, and need help in high order IADLs (finances, transportation, heavy housework, medications). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation and housework.
6. Moderately frail - people need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.
7. Severely frail - completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within 6 months).
8. Very severely frail - completely dependent, approaching the end of life. Typically, they could not recover even from a minor illness.
9. Terminally ill - approaching the end of life. This category applies to people with a life expectancy of less than 6 months, who are not otherwise evidently frail.

Scoring frailty in people with dementia

The degree of frailty corresponds to the degree of dementia. Common symptoms in mild dementia include forgetting the details of a recent event, though still remembering the event itself, repeating the same question/story and social withdrawal. In moderate dementia, recent memory is very impaired, even though they seemingly can remember their past life events well. They can do personal care with prompting.

In severe dementia, they cannot do personal care without help.

Sources:

Clinical frailty scale from Canadian Study on health and ageing, revised 2008.
K. Rockwood et al. A global measure of fitness and frailty in elderly people. CMAJ 2005; 173:489-495.

Abbreviated Mental Test Score

Record the total Abbreviated Mental Test Score, this should be a score from 0 to 10. A text description of the image follows it.

Text description of the Abbreviated Mental Test Score

Ask the following questions to the patient. Each question that is correctly answered scores one point:

1. What is your age?
2. What is the time to the nearest hour?
3. Give the patient an address, ask him/her to repeat it at the end of the test, for example 42 West Street.
4. What is the year?
5. What is the name of the hospital/number of residence where the patient is situated?
6. Can the patient recognise 2 persons (for example the doctor or nurse)?
7. What is your date of birth (day and month sufficient)?
8. In what year did World War 1 begin?
9. Name the present monarch/prime minister.
10. Count backwards from 20 to 1.

Total score out of 10.

Note:

• a score of 6 or less suggests delirium or dementia, although further tests are necessary to confirm the diagnosis

Cardiorespiratory Disease

Does the patient have severe cardiorespiratory disease?

Note:

• severe = less than ordinary physical activity or rest causes tiredness, palpitations or shortness of breath

Other Non-Breast Locally Advanced/Metastatic Malignancy

Does the patient have any other Non-Breast Locally Advanced/Metastatic Malignancy?

Dementia Diagnosis

This is a new data item for v10. Does the patient already have a known diagnosis of dementia?