Guidance

QMI introduction and summary

Published 25 August 2021

Applies to England

Introduction

The National Cancer Registration and Analysis Service (NCRAS) within Public Health England (PHE) produces statistics on cancer incidence and mortality and estimates of cancer survival in England. These outputs are annually published as official cancer statistics and provide independent commentary.

The purpose of this article is to outline the following:

• what cancer registrations are
• what cancer survival is
• the range of cancer releases published by NCRAS and the intended use of each release
• the strengths and limitations of these releases
• the users and accessibility of data

Before 2018, NCRAS collaborated with the Office for National Statistics (ONS) to produce these publications. Starting with the registration year 2018, NCRAS has taken over sole publication of the outputs. These are published on GOV.UK at the Cancer registration statistics for England collection page. Publications for registration years prior to 2018 can be found on the ONS website page Cancer registration statistics, England Statistical bulletins.

What are cancer registrations, cancer survival and life tables?

For adults, cancers are coded using the International Statistical Classification of Diseases 10th Revision (ICD-10). ICD-10 coding for cancer is based on the nature and anatomical site of the cancer.

Cancer stage at diagnosis describes the size of a tumour and how far it has spread when the patient first presents to the heath care service. It is measured and recorded according to internationally agreed standards.

The Cancer Registration Statistics is an annual publication that presents data on the number of new cancer registrations and deaths from cancer in England. The data tables released alongside the publication provide the number and age-standardised rates of cancer cases and cancer deaths by English sub-national geographies, sex, age group and cancer site.

The survival estimates are the estimation of the proportion of patients surviving their cancer after a certain number of years. Survival estimates are age-standardised wherever possible, to improve the comparability between population groups and over time. From June 2017, age-standardised estimates for adults have been calculated using the International Cancer Survival Standard (ICSS) age weightings. The ICSS weights are used so that results are comparable across all countries in the UK and Ireland.

Net-survival analysis is the method used for all adult survival statistics and involves comparing the survival of patients with cancer with background mortality (the mortality rate of the general population). Background mortality is derived from population life tables. Life tables (also called mortality tables or actuarial tables) are tables which show what the probability is that a person of that age will die before their next birthday. The life tables used are broken down by single year of age (0 to 99 years), sex, quintile of the Index of Multiple Deprivation (IMD) and region. NCRAS has created life tables to use in calculating net cancer survival. Information on the life tables used can be found in The impact of updating cancer survival methodologies for national estimates, 2019.

For more information on cancer registrations (incidence and mortality), cancer survival and the methods used for these statistics, please refer to our pages for cancer registrations methodology and cancer survival methodology.

Understanding which publication to use

Three of the bulletins relate to cancer survival, while one relates to the number of cancers diagnosed and number of deaths from cancer each year. These are described in detail below.

Cancer registration statistics, England

This publication provides the number and rate of cancer diagnoses and deaths from cancer. The estimates produced are used to measure the occurrence of cancer within the population of England. Used alongside cancer prevalence, mortality and survival, these estimates can inform policy makers on the overall burden of cancer. Included within this publication are the Experimental Statistics bulletin which relates to the number of cancers by stage at diagnosis.

Cancer survival in England

This publication provides childhood (aged 0 to 14 years) and adult (aged 15 to 99 years) 1, 5 and 10-year cancer survival in England. For adults, survival is provided overall and by cancer site, stage at diagnosis (where possible) and geographical area (NHS Region, Cancer Alliance (CA), Sustainability and Transformation Partnership (STP)). An annual trend in survival, which is estimated by variance-weighted least-squares regression of the annual survival estimates is also provided. These estimates enable the monitoring of changes in cancer survival over time. Adult cancer survival estimates are created by comparing survival rates for cancer patients with background mortality (net survival), to show the effect of a cancer diagnosis on the outcomes for patients. Unlike adult survival, childhood cancer survival estimates are calculated without comparison to the background mortality (overall survival) because few childhood cancer patients will die from another cause of death while receiving treatment.

Index of cancer survival

This provides an index of all-cancer survival by Clinical Commissioning Group (CCG), Sustainability and Transformation Partnership (STP) and Cancer Alliance (CA) in England. This index should be used to compare survival for all cancers combined (excluding non-melanoma skin cancer and prostate cancer) over time.

Conditional crude probabilities of deaths in England

This provides crude probabilities of death at different times following diagnosis, conditioned on how long a person has already survived. This statistic should be used to understand mortality that is likely to be experienced by patients and how this is affected by length of survival.

‘Cancer survival in England’, ‘Index of cancer survival’ and ‘Conditional crude probabilities of death in England’ use different methods and cannot be directly compared. For more information refer to the cancer survival methodology.

Strengths and limitations

These cancer publications have several strengths and limitations.

Main strengths

The main strengths of the cancer statistical bulletins include:

• estimates showing the effect of health policy on the survival of cancer patients in England
• cancer survival in England presents age-standardised rates wherever possible to enable users to reliably compare results over time and between areas
• the use of administrative data means that survival estimates are population-based
• these estimates can indicate the potential for improvement in the management of cancer, from early detection through to referral, investigation, treatment and care
• overall survival is considered a reliable estimator of cancer survival in children because, unlike in adults, death within 10 years of diagnosis is almost always due to the cancer
• each publication provides different breakdowns of cancer survival estimates (as outlined in Table 1)

Table 1: Breakdown of estimates provided in each cancer publication

Breakdown	Cancer registration statistics, England	Cancer survival in England	Index of cancer survival for Clinical Commissioning Groups in England	Conditional crude probabilities of death
Sex	Male and female	Male, female and persons	Persons (male and female for specific cancer sites)	Male, female and persons
Age at diagnosis	All ages	Adults (15 to 99) and children (0 to 14)	Adults (15 to 99)	Adults (15 to 99)
Cancer site	ICD10 4 digit	31 common cancers for adults, 22 cancer sites combined for children	Index includes all cancer except non-melanoma skin cancer and prostate. Lung, breast and colorectal separately.	26 cancer sites
Geographic areas	England and regions	England, Cancer Alliance, Sustainability and Transformation Partnerships and NHS Regions	Clinical Commissioning Groups, Sustainability and Transformation Partnerships, Cancer Alliance and England	England
Stage	for selected cancer sites, grouped stages 1 and 2 and stages 3 and 4	for selected cancer sites	No	No
Year at diagnosis	yearly	5 years grouped	16 years grouped	5 years grouped
Length of survival	not applicable	1 to 5 year estimates for adults, 1, 5 and 10 year estimates for children	1 year estimates for Clinical Commissioning Groups, and 1, 5 and 10 year estimates for all other geographies	1 to 5 year estimates

However, there are a few limitations of the cancer survival bulletins, which are detailed further in the following subsection.

Main limitations

The main limitations of the cancer statistical bulletins include:

• they do not show overall survival of a patient where they have been newly diagnosed with cancer but die from an unrelated condition
• these statistics are not applicable to an individual, newly diagnosed patient; the survival of a newly diagnosed individual will depend upon many other factors, such as their individual prognosis, their treatment or other diseases, and thus their survival may vary significantly from that reported by the publications
• a recognised staging system is not available for all types of cancer
• in some cases, usually due to small numbers of cases, it is impossible to produce robust estimates of survival for one or more of the age groups, cancer sites, geographies or follow-up periods; all such non-robust estimates are suppressed
• Cancer data files are dynamic and new cases can be registered ‘late’, modified and, more rarely, cancelled

Other publications released by NCRAS

As well as the statistics mentioned above, NCRAS also produces a range of regular and ad hoc publications. Regular cancer statistics from NCRAS include:

• Cancer Outcome Metrics
• Routes to Diagnosis
• Case-mix adjusted percentage cancers diagnosed a stages 1 and 2 in England
• Emergency presentations of cancer, which are published quarterly
• Cancer services at General Practitioner (GP) and CCG level, which is updated annually

NCRAS also produce other publications such as policy documents, methods papers, ad hoc pieces of research and blogs that are not set by a distinct timeframe.

• reports: detailed national and subnational reports on aspects of cancer and its treatment, including areas of inequality
• data briefings: short documents highlighting one issue and written for a wider general audience
• guidance documents: documents written to support health services and other users in understanding and using the available information
• peer-reviewed publications: articles published in peer-reviewed journals making use of the National Cancer Analysis System

Users of the data

Users of cancer survival estimates include government organisations including the NHS, local bodies responsible for commissioning cancer services, health policy makers, cancer charities, academics and researchers, cancer registries, the public, and the media.

Population-based statistics may be used to:

• plan services aimed at cancer prevention and treatment
• feed into national cancer plans – the Department of Health and Social Care (DHSC) identified cancer as a specific improvement area for preventing people dying prematurely, given that a significant gap remains in survival compared with the European average; the Independent Cancer Task Force set out 6 strategic priorities to help improve cancer survival in England, including reducing Clinical Commissioning Group (CCG) variation
• inform NHS long term plan ambitions for cancer which has set out 2 key ambitions to achieve by 2028 which are: 55,000 more people each year will survive their cancer for 5 years or more; and 75% of people with cancer will be diagnosed at an early stage (stage 1 or 2)
• inform the NHS Outcomes Framework, which was established to monitor overall changes in performance of the NHS and the quality of health outcomes, and includes 1 and 5-year net survival from colorectal, breast and lung cancers; the NHS Five Year Forward View set out: ‘that improvements in outcomes will require action on 3 fronts: better preventions, swifter access to diagnosis, and better treatment and care for all those diagnosed with cancer’
• demonstrate the pattern of survival by stage at diagnosis, to help show where earlier diagnosis could lead to improvements in survival
• provide reliable and accessible information about cancer outcomes to a wide range of groups, including patients and health professionals via health awareness campaigns, cancer information leaflets and websites
• brief parliamentary ministers and respond to parliamentary questions
• inform cancer research

Data accessibility

The latest publications can be found free of charge. Our recommended format for accessible content is a combination of HTML webpages for narrative, charts and graphs, with data being provided in usable formats such as OpenDocument Spreadsheet (.ods). In some instances, other software may be used, or may be available on request.

To ensure that all information is accessible for our users we welcome feedback on the content, format and relevance of our statistics via email. We will hold an annual stakeholder engagement event to inform future outputs.