FAQs for Patients

1. What is NATCAN?

The National Cancer Audit Collaborating Centre (NATCAN) is a new national centre of excellence which will shine a spotlight on the care and treatment of patients who are diagnosed with cancer in England and Wales. It will bring all cancer audits together under one umbrella for the first time. The aim is to strengthen NHS cancer services by examining data on treatment and patient outcomes, in order to improve quality and results. It has been commissioned to produce new cancer audits by the Healthcare Quality Improvement Partnership (HQIP), on behalf of NHS England and the Welsh Government.

2. Where is it based?

NATCAN is part of the Clinical Effectiveness Unit (CEU) in London – a collaboration between the Royal College of Surgeons of England (RCSEng) and the London School of Hygiene & Tropical Medicine (LSHTM). The CEU brings together the best clinicians (the doctors on the front line against cancer who know what the problems are) and the best academics (the data scientists and statisticians who can interpret the results generated by the data in the most effective way). It has already been working on cancer audits for more than 15 years.

3. Which cancers will NATCAN cover?

NATCAN includes six new national cancer audits in breast cancer (primary and metastatic), ovarian, pancreatic, non-Hodgkin lymphoma and kidney cancer. These audits will cover roughly 90,000 newly diagnosed patients each year. The CEU has already delivered clinical audits in prostate, lung, bowel, oesophageal and stomach cancer, and it recently completed an audit of breast cancer in older patients. Over the next few years all these audits will become part of NATCAN. The aim is to deliver closer collaboration and better results, sharing learning and best practice.

4 Who pays for it?

NATCAN, comprising six new audits, is funded by NHS England and the Welsh Government, with £5.4m for an initial period of three years.

5. How will NATCAN work?

NATCAN is all about effective collaboration. Bringing senior doctors and academics together will ensure that we ask the right questions about cancer care and treatment, and then use the right methods to answer those questions. We’ll also work closely with different stakeholders including patient groups, to try to ensure that more people recover from cancer and lead longer healthier lives.

6. What do clinical audits actually do?

Clinical audit is a method that healthcare professionals use to look at and improve patient care. They compare how patients are treated, and the outcomes of the care they receive, against set standards and guidelines.

The audits in NATCAN use information on the care received by patients diagnosed with cancer in hospitals across England and Wales. They examine this data in order to make  valid comparisons, and identify improvements where they are needed. The audits which have already been delivered have helped provide a wider understanding of cancer treatments, and created better results for patients. They have also promoted improvement initiatives within NHS cancer services, and identified areas of best practice.

7. Why are there so many cancer audits?

It’s important to remember that not all cancers are the same. So, we need to focus on each type of cancer individually. For example, over 70% of patients diagnosed with primary breast cancer will still be alive after ten years, but only 5% of patients diagnosed with pancreatic cancer will survive for ten years. We need to try to improve that.

8. What kind of information do you use?

We use information about patients that is collected by national organisations in England and Wales. These organisations include the National Cancer Registration and Analysis Service (NCRAS) in England and the Wales Cancer Network. They are allowed to collect data on patients diagnosed with cancer, the treatments they receive, and the results of these treatments.

9. Will lots of people see my personal information?

No. All the data we use is anonymised, and doesn’t include the names of any individual patients or information such as an NHS number.

10. Is the kind of information you can collect changing?

Yes. We now have access to more rapid cancer data, which is available three months after diagnosis. More traditional cancer data is only available eighteen months after diagnosis. This is a key innovation, which means NATCAN can feed results back to hospitals more frequently, to enable them to improve their cancer services. We can also measure whether these improvements are having the desired results.

The emergence of rapid data was driven by the Covid pandemic, and we are already using it to good effect in existing audits, to improve the diagnosis and treatment of patients.

11. What’s the difference between the two types of data?

In general terms, what we call the gold standard data is a much richer dataset which gives more detailed information about cancer. It might for example provide data on what particular cancer cells look like under a microscope, which may tell us whether they are likely to be more aggressive.

The rapid data has information about the patient, their diagnosis and their treatments. It has more limited information about the tumour – it only gives us information on staging, which is how medical experts determine the extent to which a cancer has grown and spread. So it can be really useful because it is available so quickly, but we still need the gold standard data to give us a more sophisticated analysis.

12. How will NATCAN help me as a patient?

Our audits don’t just examine data about the cancers themselves, they also look at different hospitals and different methods of treatment. That means NATCAN will  focus on how cancer care varies from one hospital to another, with the aim of learning lessons and identifying how we can fight different cancers most effectively.

We will make recommendations to hospitals based on our findings, which will include:

• How patients are diagnosed
• The treatments patients receive such as the use of surgery, radiotherapy and/or chemotherapy
• Outcomes following treatment

To make fair comparisons, we also take account of the facts that all patients are different and have different characteristics. Among the factors we consider are age, whether a patient has pre-existing conditions, and the social or economic circumstances that patients find themselves in. When the data tells us where improvements are needed, NATCAN will lead the drive to deliver change.

13. Can I be more involved as a patient?

Yes, patient involvement is central to everything we do. We are determined to give patients and carers a greater voice at every stage of the process. NATCAN will work with various patient charities, to create a patient forum for each cancer audit. These patients will help ensure that the questions we ask in the audits are appropriate, and that we are reporting information in ways that are useful to the public as well as to health care professionals and hospitals.

14. What are the next steps?

We now have our teams in place, and the next steps are to work with professionals and patients to make sure we ask the right questions and the quality improvement goals for each of the new audits are clear. Once the audit questions have been finalised, and the data has been gathered and analysed, we hope to be publishing results beginning in early 2024. We will also prepare short state-of-the-nation reports for each cancer audit, which will each include five specific recommendations. We aim to publish these reports by September 2024.