Management of oesophago-gastric (OG) cancer
Survival after OG cancer surgery
Interpretation of funnel plots
Management of oesophago-gastric (OG) cancer
This section provides information on the diagnosis and treatment of people with oesophageal or stomach (gastric) cancer. The information covers key elements of the pathway including diagnosis, waiting times and supportive care.
People with OG cancer are typically diagnosed after they are referred by their general practitioner. However, some patients will be diagnosed after an emergency admission at hospital. This is less desirable because these patients are often diagnosed with more advanced cancer than those referred by their GP.
All people diagnosed with OG cancer should be able to access an OG clinical nurse specialist (CNS) through their multidisciplinary team.
For details of the data and methods used by the audit to produce indicators, please refer to our methodology supplement.
Survival after OG cancer surgery
This section provides information on survival outcomes for people with OG cancer who have curative surgery, for NHS trusts that undertake OG surgery.
For details of the data and methods used by the audit to produce indicators, please refer to our methodology supplement.
Things to consider:
Considerable care should be taken in making comparisons between NHS organisations on the basis of the figures reported here, as outcomes may vary due to random variation, case-mix or data quality. The NOGCA does not accept any liability arising from errors or omissions, or the use of, or reliance on, the information contained in this website and reserve the right to change the information and descriptions when required.
In looking at this information, it is important to remember that the outcomes of NHS trusts may vary because of patient characteristics and the influence of random variation. We recommend that patients discuss the likely outcomes of their treatment with their provider, so that they can understand the expected outcomes given their own circumstances.
Interpretation of funnel plots
Organisational outcome information will always differ from the outcome figures at a national level because of random variation – some NHS organisations will have higher values and some lower. This variation is not communicated when figures are ranked. Consequently, NHS organisations should not be ranked, as this would be misleading.
The variation in postoperative survival is displayed using a graph known as a funnel plot. The benefit of this approach is that it shows whether the outcomes for individual NHS trusts differ from the national average by more than would be expected due to random fluctuations. Random variation will always affect outcome information like survival, and its influence is greater among small samples.
On these plots, each dot represents an English NHS trust and they are centred on the national average. Example: The national average for 90-day postoperative survival is approximately 96.4%. The vertical axis indicates the outcome, with dots higher up the axis showing NHS trusts with better survival. The horizontal axis shows surgical activity with dots further to the right showing the NHS organisations which perform more operations.
Funnel plots include control limits to define the range within which we would expect NHS trusts’ outcomes to lie. Following convention, we use 99.8% control limits. It is unlikely for an NHS organisation to fall beyond these limits solely because of random variation (a 1 in 500 chance). If the outcome figures for an NHS trust fell outside the outer limits, there could be a systematic reason for the higher or lower rate, and they would be flagged as an outlier for further investigation. The main cause of variation within the control limits is likely to be random variation.