Improving outcomes for people with skin tumours including melanoma

1
Improving Outcomes for
People with Skin Tumours
including Melanoma
Background
Patterns of service provision
The only routinely available sources of data on health service use for
skin cancer collated at a national level are Hospital Episodes Statistics
(HES) for England and the Patient Episode Database in Wales
(PEDW). These data capture inpatient admissions and day case
procedures but not outpatient activity. This means that they only
record a small proportion of the overall NHS activity for skin cancer
patients as many are managed in primary care, and of those managed
in hospital most will be managed as outpatients. This has been
confirmed by a study undertaken in two trusts to compare the
numbers of skin cancer cases reported by histopathology and HES
activity for the period 1995–2002 (see Evidence Review). Only 36% of
MM and 41% of NMSC pathology data were reflected in the HES data.
This contrasts with most other cancer types where the majority of
patients will have at least one hospital admission.
Coding variations between hospitals for the classification of skin
cancer procedures as outpatient or day cases limit the usefulness of
the data for local comparisons. However, as there is no other source,
HES and PEDW data still give some important insights into trends in
service provision and who delivers these services for the most severe
cases.
Using these data, a gradual increase in the rate of episodes of care for
MM and NMSC patients is seen in England and Wales [26] (Figures 11
and 12). The figures for 1997 reflect inadequate data capture processes
resulting from coding changes at that time.
Figure 11. Rates of episodes of inpatient care for MM,
England (E) and Wales (W)
Age standardised rate (per 100,000)
25
20
15
10
5
0
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1995 1996 1997 1998 1999 2000 2001
Year
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Male (E)
Female (E)
Male (W)
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Female (W)
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22 National Institute for Health and Clinical Excellence