NHS Information Authority

Data Standards Programme

Reference:	Change Request 338
Version No:	1.15
Subject:	QMCW - Cancer Waiting Times
Type of Change:	Change to QMCW Central Return Form Guidance
Effective Date:	1 September 2003
Reason for Change:	To monitor progress against the 2002 breast cancer waiting time target through a QMCW return as a short term measure. This return will be discontinued when data quality in the new Cancer Waiting Times Database reaches acceptable levels.

Background:

DSCN 15/2003 was issued in order to extend an already standardised data collection method to report against the 2002 breast cancer target - guarantee of maximum two month wait from GP referral to treatment for breast cancer.

This is an interim method that will be used until the Cancer Waiting Times Database is completely populated by all acute trusts, and robust data is generated. The Cancer Waiting Times Database will become the primary method of reporting the progress of organisations against waiting times targets for cancer patients once it holds a comprehensive set of data, and the QMCW collection will then cease.

DSCN 30/2002 Data Standards: Monitoring of Cancer Waiting Times modelled the changes required for the national cancer database. This DSCN updates the guidance in the NHS Data Dictionary for the extended QMCW.

Summary of changes:

Central Return Forms
QMCW 1	Change guidance text
QMCW 2	Change guidance text
QMCW 3	Change guidance text
QMCW 4	Change guidance text
QMCW 5	New Form
Diagrams
QMCW CANCER WAITING TIMES MONITORING THE "TWO WEEK" TARGET	Change to aliases
QMCW CANCER WAITING TIMES MONITORING THE "TWO WEEK" TARGET	Change to diagram contents

Name:	Barbara Fogarty
Date:	1 July 2003
Sponsor:	Data and Information Standards Programme

Note: Additions shown in highlighted with a blue background. Deletions are shown using strikeout.

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QMCW 1

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Change to Central Return Form: Change guidance text

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Contextual Overview

1. In terms of cancer waiting times, the Department of Health require information on waiting times for all PATIENTS urgently referred by their GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER for suspected cancer by tumour site to monitor the following targets:

   	The "two week wait" from the date of decision to refer to the time the patient was seen by cancer specialist services, as described in the White Paper 'The New NHS'.
   	The maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia and the maximum one month wait from diagnosis to treatment for breast cancer. These targets are described in the NHS Cancer Plan, published in September 2000.

1. In terms of cancer waiting times, the Department of Health require information on waiting times for all PATIENTS urgently referred by their GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER for suspected cancer by tumour site to monitor the following targets:

   	The "two week wait" from the date of decision to refer to the time the patient was seen by cancer specialist services, as described in the White Paper 'The New NHS'.
   	The maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
   	The maximum one month wait from diagnosis to treatment for Breast Cancer.
   	The maximum two month wait from urgent GP referral to treatment for Breast Cancer. These targets are described in the NHS Cancer Plan, published in September 2000.

2. The QMCW will monitor performance against these targets.

   NHS TRUST.

2. The QMCW will monitor performance against these targets.

Completing Return QMCW - Cancer Waiting Times - Monitoring the Targets

3. QMCW is a quarterly return, the first quarter starting on 1 April and the last quarter ending on 31 March. Returns must be submitted by the twenty fifth working day after the end of the quarter. It comprises 4 parts:

   Part One:	Urgent referrals received within 24 hours
   Part Two:	Urgent referrals not received within 24 hours
   Part Three:	Guarantee of maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
   Part Four:	Guarantee of maximum one month wait for all referrals from diagnosis to treatment for breast cancer

3. QMCW is a quarterly return, the first quarter starting on 1 April and the last quarter ending on 31 March. Returns must be submitted by the twenty fifth working day after the end of the quarter. It comprises 5 parts:

   Part One:	Urgent referrals received within 24 hours
   Part Two:	Urgent referrals not received within 24 hours
   Part Three:	Guarantee of maximum one month wait from urgent GP referral to treatment for Children's Cancers, Testicular Cancers and Acute Leukaemia
   Part Four:	Guarantee of maximum one month wait for all referrals from diagnosis to treatment for Breast Cancer
   Part Five:	Guarantee of maximum two month wait from GP referral to treatment for Breast Cancer

4. QMCW is completed by NHS TRUST.

4. QMCW is completed by the NHS TRUST where the patient is first seen for Parts One and Two and where the first definitive treatment is administered for Parts Three to Five.

5. The QMCW return requires the ORGANISATION CODE and ORGANISATION NAME of the NHS TRUST as well as the name of a contact, the contact's job title and the contact telephone number and fax number on the front page.

Parts One and Two

6. Comprehensive information on defining the two week standard can be found in the following Health Service Circulars:

   HSC 1998/242	Breast Cancer Waiting Times - Achieving the two week target
   HSC 1999/084	Collection of information on waiting times for suspected breast cancer patients in 1999/2000
   HSC 1999/205	Cancer Waiting Times. Achieving the two week target

7. PATIENTS are included on the return where the OUT-PATIENT ATTENDANCE CONSULTANT is a FIRST ATTENDANCE and the ATTENDANCE DATE is during the period of the quarter covered by the return.

7. PATIENTS are included on the return where the DATE FIRST SEEN is during the period of the quarter covered by the return.

8. Parts One and Two comprise 13 main lines (Lines (a) - (m)) to report separately on PATIENTS with different forms of suspected cancer. These are classifications of URGENT CANCER REFERRAL TYPE.

8. Parts One and Two comprise 13 main lines (Lines (a) - (m)) to report separately on PATIENTS with different forms of suspected cancer. These are URGENT CANCER REFERRAL TYPES.

Section a:	Breast Cancer
Section b:	Children's Cancers (these are PATIENTS under 16 years of age)
Section c:	Lung cancer
Section d:	Haematological malignancies including leukaemia
Section d:	Haematological Malignancies and Acute Leukaemia
Section e:	Upper Gastrointestinal Cancers
Section f:	Lower Gastrointestinal Cancers
Section g:	Skin Cancers
Section h:	Gynaecological Cancers
Section i:	Brain/Central Nervous system Tumours
Section j:	Urological Cancers
Section j:	Urological Cancers and Testicular Cancer
Section k:	Head and Neck Cancers
Section l:	Sarcomas
Section m:	Others

9. Totals for all cancers under these sections are included at the bottom of the form.

10. Referrals cover all GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE classification. These requests can be written or verbal, and can include those sent by electronic mail or using a telephone direct booking system.

10. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from General Medical Practitioner or 92 General Dental Practitioner and CANCER REFERRAL PRIORITY TYPE 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner. These requests can be written or verbal, and can include those sent by electronic mail or using a telephone direct booking system.

11. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

12. For monitoring purposes Parts One and Two requires information on referrals to distinguish between those referrals received within 24 hours of the CANCER REFERRAL DECISION DATE (by end of the next calendar day) and those which were not. The REFERRAL REQUEST RECEIVED DATE should be used by the NHS Trust to calculate this interval.

12. For monitoring purposes Parts One and Two require information on referrals to distinguish between those referrals received within 24 hours of the CANCER REFERRAL DECISION DATE (by end of the next calendar day) and those which were not. The REFERRAL REQUEST RECEIVED DATE should be used by the NHS Trust to calculate this interval.

Part Three

13. Part Three monitors the waiting time in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse for Children's Cancers, Testicular Cancers and Acute Leukaemia to the date of the first definitive treatment if it is within the quarter.

14. Referrals cover all GP REFERRAL REQUEST with an CANCER REFERRAL DECISION DATE and an URGENT CANCER REFERRAL TYPE of b. Children's cancers, d.i. Acute leukaemia or j.i. Testicular cancers.

14. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from General Medical Practitioner or 92 General Dental Practitioner and CANCER REFERRAL PRIORITY TYPE of 01 Urgent referral for suspected cancer from a General Medical Practitioner or a General Dental Practitioner with a PRIMARY DIAGNOSIS (ICD) of Children's Cancer, Acute Leukaemia or Testicular Cancer.

15. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

16. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

16. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

Part Four

17. Part Four monitors the waiting time in calendar days from the date of the diagnosis to the date of the first definitive treatment for all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

17. Part Four monitors the waiting time in calendar days from the date of the diagnosis to the date of the first definitive treatment for all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of 01 Suspected breast cancer.

18. The date of diagnosis is taken to be the date that the decision was made to treat the patient, which is the DECISION TO TREAT DATE.

19. As with Part Three, the date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

19. As with Part Three, the date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

Part Five

20. Part Five monitors the waiting time in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer for Breast Cancer to the date of the first definitive treatment if it is within the quarter.

21. Referrals cover all REFERRAL REQUESTS with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and a CANCER REFERRAL PRIORITY TYPE of 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner with an CANCER REFERRAL DECISION DATE and a PRIMARY DIAGNOSIS (ICD) of Breast Cancer.

22. The date the GP decides to refer a PATIENT is the CANCER REFERRAL DECISION DATE. This date is stated on the referral letter or is derived from the date of the letter or e-mail or telephone call whichever is the earlier.

23. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

Waiting Times for Parts One and Two

24. The waiting time is measured in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse to the OUT-PATIENT ATTENDANCE CONSULTANT of the OUT-PATIENT APPOINTMENT CONSULTANT made in respect of the urgent cancer referral, where FIRST ATTENDANCE is First attendance. Note that all out-patient referrals for suspected cancer where the first attendance is for endoscopy should be in Parts One and Two.

24. The waiting time is measured in calendar days from the date that the CANCER REFERRAL DECISION DATE to the DATE FIRST SEEN. Note that all out-patient referrals for suspected cancer where the first attendance is for endoscopy should be in Parts One and Two.

Patients who refuse an offer of an appointment

25. DSCN 23/2000 provided the following guidance on these Patient refusals:

    "Patient's views should be considered when monitoring the two week rule and some patients might, for social or personal reasons, decline an appointment within 14 days. The waiting time of these patients who are offered an appointment but turn it down should be calculated from the date of the last appointment they were offered."

    and

    "If a patient makes it clear that they do not want an appointment within 14 days before an offer is made, e.g. because they are going on holiday, the patient should be excluded from the QMCW return and monitoring of the 'two week' standard until the date when they become available for an appointment."

    Both of the above are not currently supported by the NHS Data Dictionary and local arrangements for calculation of waiting times based upon the above guidance will be necessary until fully supported by the NHS Data Dictionary.

Patients who do not attend their out-patient appointment

26. For PATIENTS who fail to attend, whether giving advance notice or not, the waiting time is from APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

26. For PATIENTS who fail to attend, whether giving advance notice or not, the waiting time will be adjusted. This is the WAITING TIME ADJUSTMENT (FIRST SEEN).

27. PATIENTS who are referred back to their GP after failing to attend should only be counted again for Parts One and Two when they are re-referred for an urgent cancer referral. The waiting time should be calculated from the latest CANCER REFERRAL DECISION DATE of the re-referral.

Waiting times for Part Three

Waiting times for Parts Three and Five

28. The waiting time is measured in calendar days from the date that the GENERAL MEDICAL PRACTITIONER or GENERAL DENTAL PRACTITIONER decided to refer a PATIENT who needs to be seen urgently with a suspected primary cancer or suspected cases of relapse to the date of definitive treatment (See Paragraph 15, above).

28. The waiting time is measured in calendar days from the CANCER REFERRAL DECISION DATE to the date of definitive treatment (See Paragraph 15, above).

29. If the patient fails to attend or defers treatment, the waiting time will be adjusted. If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

30. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

    	The time from the CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
    	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
    	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

    If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT, plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

30. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

    	WAITING TIME ADJUSTMENT (FIRST SEEN) records the number of days that should be removed from the derived waiting time between the CANCER REFERRAL DECISION DATE and DATE FIRST SEEN.
    	WAITING TIME ADJUSTMENT (DECISION TO TREAT) records the number of days that should be removed from the derived waiting time between DATE FIRST SEEN and DECISION TO TREAT DATE.
    	WAITING TIME ADJUSTMENT (TREATMENT) records the number of days that should be removed from the derived waiting time between DECISION TO TREAT DATE and start date of the FIRST DEFINITIVE TREATMENT PROVIDED.

    If the patient is responsible for the delay in the start date of the treatment for any of these waiting time periods, the waiting time is calculated as the start date of the first treatment minus the CANCER REFERRAL DECISION DATE minus the sum of the three waiting time adjustments above.

Waiting times for Part Four

31. The waiting time is measured in calendar days from the DECISION TO TREAT DATE to the date of definitive treatment (See Paragraph 15, above).

31. The waiting time is measured in calendar days from the DECISION TO TREAT DATE to the date of definitive treatment.

32. If the patient fails to attend or defers treatment, the waiting time will be adjusted. If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

32. If the patient fails to attend or defers treatment, the waiting time will be adjusted, this is the WAITING TIME ADJUSTMENT (TREATMENT). If the patient's treatment is cancelled or deferred by the health care provider the waiting time is not adjusted.

33. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

34. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

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QMCW 2

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Change to Central Return Form: Change guidance text

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Parts One and Two

1. Note: The same format is used for all 13 Lines of Parts One and Two. The detailed description of Line (a) Breast Cancer below applies to all subsequent lines for each specific URGENT CANCER REFERRAL TYPE, see PATIENT.

PATIENT

(a) Breast Cancer

2. Line (a) relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

1. Note: The same format is used for all 13 Lines of Parts One and Two. The detailed description of Line (a) Breast Cancer below applies to all subsequent lines for each specific URGENT CANCER REFERRAL TYPE.

   (a) Breast Cancer

2. Line (a) relates to all PATIENTS with a REFERRAL REQUEST with a SOURCE OF REFERRAL FOR OUT-PATIENTS of 03 referral from General Medical Practitioner or 92 General Dental Practitioner an URGENT CANCER REFERRAL TYPE of 01 Suspected breast cancer.

Part one. Urgent referrals received within 24 hours

2. The first section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is within 24 hours of the CANCER REFERRAL DECISION DATE. Note; a referral will be considered to have been received within 24 hours if it is received by the next calendar day after the CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist within 14 days of the decision to refer by their GP

3. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the CANCER REFERRAL DECISION DATE.

3. This counts the number of PATIENTS where the DATE FIRST SEEN was within 14 days of the CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist after 14 days of the decision to refer by their GP

4. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

4. This counts the number of PATIENTS where the DATE FIRST SEEN was after 14 days of the CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

5. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend. PATIENT

   (Waiting Time Calculation)

   The calculation of the waiting time for these PATIENTS is from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

5. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the last OUT-PATIENT APPOINTMENT they failed to attend.

   (Waiting Time Calculation)

   The calculation of the waiting time for these PATIENTS is from the CANCER REFERRAL DECISION DATE to the DATE FIRST SEEN minus the WAITING TIME ADJUSTMENT (FIRST SEEN).

Seen 15 to 16 days

6. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

6. This counts the number of PATIENTS whose DATE FIRST SEEN took place 15 to 16 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 17 to 21 days

7. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

7. This counts the number of PATIENTS whose DATE FIRST SEEN took place 17 to 21 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 22 to 28 days

8. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

8. This counts the number of PATIENTS whose DATE FIRST SEEN took place 22 to 28 days after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen after 28 days

9. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend.

9. This counts the number of PATIENTS whose DATE FIRST SEEN took place 29 days or more after the CANCER REFERRAL DECISION DATE.

   This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the last OUT-PATIENT APPOINTMENT they failed to attend.

All Cancers Total

10. This is the total of all PATIENTS counted in this part of the form, sub-divided by waiting time.

Part two. Urgent referrals not received within 24 hours

11. The second section counts all urgent cancer referrals received by NHS Trusts where the REFERRAL REQUEST RECEIVED DATE is not within 24 hours of the CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist within 14 days of the decision to refer by their GP

12. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance was within 14 days of the CANCER REFERRAL DECISION DATE.

12. This counts the number of PATIENTS where the DATE FIRST SEEN was within 14 days of the CANCER REFERRAL DECISION DATE.

Number of patients seen during the quarter by a specialist after 14 days of the decision to refer by their GP

13. This counts the number of PATIENTS where the ATTENDANCE DATE of the OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance resulting from this referral was after 14 days of the CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

13. This counts the number of PATIENTS where the DATE FIRST SEEN was after 14 days of the CANCER REFERRAL DECISION DATE. The count is further analysed by waiting time interval.

14. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the the last OUT-PATIENT APPOINTMENT they failed to attend.

    The calculation of the waiting time for these PATIENTS is from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT within CONSULTANT OUT-PATIENT EPISODE with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

14. This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended after 14 days from the last OUT-PATIENT APPOINTMENT they failed to attend.

    The calculation of the waiting time for these PATIENTS is from the CANCER REFERRAL DECISION DATE to the DATE FIRST SEEN minus the WAITING TIME ADJUSTMENT (FIRST SEEN).

Seen 15 to 16 days

15. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 15 to 16 days after the CANCER REFERRAL DECISION DATE. see 6. for these PATIENTS

    This count should also include the number of PATIENT who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

15. This counts the number of PATIENTS whose DATE FIRST SEEN took place 15 to 16 days after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 15 to 16 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 17 to 21 days

16. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 17 to 21 days after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

16. This counts the number of PATIENTS whose DATE FIRST SEEN took place 17 to 21 days after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 17 to 21 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen 22 to 28 days

17. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 22 to 28 days after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the the last OUT-PATIENT APPOINTMENT they failed to attend.

17. This counts the number of PATIENTS whose DATE FIRST SEEN took place 22 to 28 days after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 22 to 28 days after the last OUT-PATIENT APPOINTMENT they failed to attend.

Seen after 28 days

18. This counts the number of PATIENTS whose OUT-PATIENT ATTENDANCE CONSULTANT with a FIRST ATTENDANCE of First attendance took place 29 days or more after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the the last OUT-PATIENT APPOINTMENT they failed to attend.

18. This counts the number of PATIENTS whose DATE FIRST SEEN took place 29 days or more after the CANCER REFERRAL DECISION DATE.

    This count should also include the number of PATIENTS who failed to attend their OUT-PATIENT APPOINTMENT but subsequently attended and were seen 29 days or more after the last OUT-PATIENT APPOINTMENT they failed to attend.

All Cancers Total

19. This is the total of all PATIENTS counted in this part of the form, sub-divided by waiting time.

PATIENT

Lines (b) to (m)

Lines (b) to (m)

20. Line (b) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected children's cancers.

20. Line (b) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected children's cancer.

21. Line (c) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lung cancer.

21. Line (c) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected lung cancer.

22. Line (d) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected haematological malignancies including leukaemia.

22. Line (d) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected haematological malignancies or Suspected acute leukaemia.

23. Line (e) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected upper gastrointestinal cancers.

23. Line (e) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected upper gastrointestinal cancers.

24. Line (f) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected lower gastrointestinal cancers.

24. Line (f) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected lower gastrointestinal cancers.

25. Line (g) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected skin cancers.

25. Line (g) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected skin cancers.

26. Line (h) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected gynaecological cancers.

26. Line (h) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected gynaecological cancers.

27. Line (i) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected brain/central nervous system tumours.

27. Line (i) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected brain or central nervous system tumours.

28. Line (j) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected urological cancers.

28. Line (j) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected urological cancers or Suspected testicular cancer.

29. Line (k) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected head and neck cancers.

29. Line (k) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected head and neck cancers.

30. Line (l) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Suspected sarcomas.

30. Line (l) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Suspected sarcomas.

31. Line (m) of Parts One and Two relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of Other suspected cancer.

31. Line (m) of Parts One and Two relates to all PATIENTS with an URGENT CANCER REFERRAL TYPE of Other suspected cancer.

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QMCW 3

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Change to Central Return Form: Change guidance text

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Part Three - Guarantee of maximum one month wait from urgent GP referral to treatment

Note: The same format is used for the three sections. The detailed description of Children's Cancers, below applies to the two subsequent sections for Testicular Cancers and Acute Leukaemia. The detailed description of Children's Cancer, below applies to the two subsequent sections for Testicular Cancer and Acute Leukaemia.

Children's Cancer

1. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of b Suspected children's cancers.

1. This line relates to all PATIENTS where the SOURCE OF REFERRAL FOR OUT-PATIENTS is 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and the CANCER REFERRAL PRIORITY TYPE is 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner and a PRIMARY DIAGNOSIS (ICD) of Children's cancer has been made.

Number of patients treated during the quarter within one month of the decision to refer by their GP

2. This counts the number of PATIENTS where the number of days from the CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is 31 or less.

3. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

3. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

4. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

   	The time from the CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT.
   	The time from the OUT-PATIENT ATTENDANCE CONSULTANT to the first offered START DATE of treatment.
   	The time from the first offered START DATE of treatment to the actual START DATE of treatment.

   If the patient is responsible for the delay in the START DATE of the treatment, the second of these time periods should be deducted from the waiting period. In this situation the waiting time therefore comprises the time from the CANCER REFERRAL DECISION DATE to the OUT-PATIENT ATTENDANCE CONSULTANT plus the time from the first offered START DATE of treatment to the actual START DATE of treatment.

4. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

   	WAITING TIME ADJUSTMENT (FIRST SEEN) records the number of days that should be removed from the derived waiting time between the CANCER REFERRAL DECISION DATE and DATE FIRST SEEN .
   	WAITING TIME ADJUSTMENT (DECISION TO TREAT) records the number of days that should be removed from the derived waiting time between the DATE FIRST SEEN and DECISION TO TREAT DATE.
   	WAITING TIME ADJUSTMENT (TREATMENT) records the number of days that should be removed from the derived waiting time between the DECISION TO TREAT DATE and start date of the FIRST DEFINITIVE TREATMENT PROVIDED.

5. If the patient is responsible for the delay in the start date of the treatment for any of these waiting time periods, the waiting time is calculated as the start date of the first treatment minus the CANCER REFERRAL DECISION DATE minus the sum of the three waiting time adjustments above.

Number of patients treated during the quarter NOT treated within one month.

5. This counts the number of PATIENTS where the number of days from the CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

But treated within 38 days of the decision to refer by their GP

6. This counts the number of PATIENTS where the number of days from the CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 31 but less than 39.

7. The next three sections,

   	'But treated between 39 and 48 days from the decision to refer by their GP'
   	'But treated between 49 and 60 days from the decision to refer by their GP'
   	'And not treated within 60 days of the decision to refer by their GP'

   
   

   are treated in the same way as described in Paragraph 6 above.

Testicular Cancers

8. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of j.i Testicular cancer.

Acute Leukaemia

8. This line relates to all PATIENTS where the SOURCE OF REFERRAL FOR OUT-PATIENTS is 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and the CANCER REFERRAL PRIORITY TYPE is 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner and a PRIMARY DIAGNOSIS (ICD) of testicular cancer has been made.

   Acute Leukaemia

9. This line relates to all PATIENTS where the SOURCE OF REFERRAL FOR OUT-PATIENTS is 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and the CANCER REFERRAL PRIORITY TYPE is 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner and a PRIMARY DIAGNOSIS (ICD) of acute leukaemia has been made.

9. This line relates to all PATIENTS with a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of d.i Acute Leukaemia.

9. The lines on Testicular Cancers and Acute Leukaemia are completed in the same way as the lines on Children's Cancers.

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QMCW 4

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Change to Central Return Form: Change guidance text

Central Return Form Guidance

QMCW - Cancer Waiting Times - Monitoring the Targets

Part Four - Guarantee of maximum one month wait from diagnosis to treatment for breast cancer

1. This section relates to all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer.

1. This section relates to all PATIENTS with a diagnosis of breast cancer who are treated in the quarter, including those referred by the GP with an URGENT CANCER REFERRAL TYPE of 01 Suspected breast cancer.

Total number of patients treated during the quarter

2. This section is subdivided into the following.

GP urgent referrals

3. This counts the number of patients who are the subject of a GP REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of a. Suspected breast cancer and a CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

3. This counts the number of PATIENTS who are the subject of a REFERRAL REQUEST with an URGENT CANCER REFERRAL TYPE of 01 Suspected breast cancer and a CANCER REFERRAL PRIORITY TYPE of 01 - Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner who have been treated in the quarter.

Other referrals

4. This counts all PATIENTS with a PATIENT DIAGNOSIS of breast cancer other than those with a GP REFERRAL REQUEST where the CANCER REFERRAL PRIORITY TYPE of 2 - Urgent cancer referral identified by GP who have been treated in the quarter.

4. This counts all PATIENTS with a PRIMARY DIAGNOSIS (ICD) of breast cancer other than those with a REFERRAL REQUEST where the CANCER REFERRAL PRIORITY TYPE of 01 - Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner, who have been treated in the quarter.

Number of patients treated during the quarter within one month of the date of a clinical diagnosis being made by a responsible specialist

5. This counts the number of patients where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is 31 or less.

6. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE of the HOSPITAL PROVIDER SPELL. For Radiotherapy it is the START DATE of the RADIOTHERAPY TREATMENT COURSE. For Chemotherapy it is the START DATE of the ANTI-CANCER DRUG PROGRAMME. For Palliative Care it is the START DATE of the PALLIATIVE CARE EPISODE. For those patients for whom no cancer treatment is provided, because either the patient refuses treatment or no treatment is appropriate or the patient is only being monitored (Watchful Waiting) it is the CARE PLAN AGREED DATE.

6. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

Waiting Time Calculations

7. For admitted patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the date of the missed OFFER OF ADMISSION to the date when they actually were admitted, i.e. the START DATE of the HOSPITAL PROVIDER SPELL.

8. For out-patients, if the patient fails to attend or defers their treatment, the waiting time is calculated from the APPOINTMENT DATE of the last OUT-PATIENT APPOINTMENT with an ATTENDED OR DID NOT ATTEND indicator of Did not attend - no advance warning given, Patient arrived late and could not be seen or Appointment cancelled by the patient to the ATTENDANCE DATE of the first OUT-PATIENT ATTENDANCE CONSULTANT within the CONSULTANT OUT-PATIENT EPISODE with a FIRST ATTENDANCE of First attendance.

7. If the patient fails to attend or defers their treatment a WAITING TIME ADJUSTMENT (TREATMENT) is made. This records the number of days that should be removed from the derived waiting time between DECISION TO TREAT DATE and start date of the FIRST DEFINITIVE TREATMENT PROVIDED.

8. The waiting time is calculated as the start date of the first treatment minus the DECISION TO TREAT DATE minus the WAITING TIME ADJUSTMENT (TREATMENT).

Number of patients treated during the quarter NOT treated within one month of the date of the clinical diagnosis being made by a responsible specialist.

8. This counts the number of PATIENT where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

8. This counts the number of PATIENTS where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31. These counts are divided into those treated within 38, 48, 60 and more than 60 days.

But treated within 38 days of the date of that same clinical diagnosis

9. This counts the number of PATIENTS where the number of days from the DECISION TO TREAT DATE to the date of the first definitive treatment is more than 31 but less than 39.

10. The next three sections,

    	'But treated between 39 and 48 days from the date of that same clinical diagnosis'
    	'But treated between 49 and 60 days from the date of that same clinical diagnosis'
    	'And not treated within 60 days of the date of that same clinical diagnosis'

    are treated in the same way as described in Paragraph 10 above.

10. The next three sections,

    	'But treated between 39 and 48 days from the date of that same clinical diagnosis'
    	'But treated between 49 and 60 days from the date of that same clinical diagnosis'
    	'And not treated within 60 days of the date of that same clinical diagnosis'

    are treated in the same way as described in Paragraph 9 above.

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QMCW 5

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Change to Central Return Form: New Form

QMCW - Cancer Waiting Times - Monitoring the Targets

Part Five - Guarantee of maximum two month wait from urgent GP referral to treatment for breast cancer

Breast Cancer

1. This line relates to all PATIENTS where the SOURCE OF REFERRAL FOR OUT-PATIENTS is 03 referral from a General Medical Practitioner or 92 General Dental Practitioner and the CANCER REFERRAL PRIORITY TYPE is 01 Urgent referral for suspected cancer from a General Medical Practitioner or General Dental Practitioner and a PRIMARY DIAGNOSIS (ICD) of breast cancer has been made.

Number of patients treated during the quarter within two months (62 days) of the decision to refer by their GP

2. This counts the number of PATIENTS where the number of days from the CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is 62 or less.

3. The date of the first definitive treatment depends on the type of treatment given. For admitted patients it is the START DATE (SURGERY HOSPITAL PROVIDER SPELL). For Radiotherapy it is the START DATE (BRACHYTHERAPY TREATMENT COURSE) or START DATE (TELETHERAPY TREATMENT COURSE) as appropriate. For Chemotherapy it is the START DATE (ANTI-CANCER DRUG REGIMEN). For Specialist Palliative Care it is the START DATE (SPECIALIST PALLIATIVE TREATMENT COURSE). For those patients for whom none of the defined treatment types apply, because either the patient refuses treatment or none is appropriate (see NO CANCER TREATMENT REASON for situations when treatment is not appropriate) and the patient is receiving symptomatic support and is being monitored it is the START DATE (ACTIVE MONITORING).

4. To calculate adjustments in waiting times when the patient does not attend for, or defers, their treatment it is useful to view the waiting time as comprising three sections:

   	WAITING TIME ADJUSTMENT (FIRST SEEN) records the number of days that should be removed from the derived waiting time between the CANCER REFERRAL DECISION DATE and DATE FIRST SEEN .
   	WAITING TIME ADJUSTMENT (DECISION TO TREAT) records the number of days that should be removed from the derived waiting time between the DATE FIRST SEEN and DECISION TO TREAT DATE.
   	WAITING TIME ADJUSTMENT (TREATMENT) records the number of days that should be removed from the derived waiting time between the DECISION TO TREAT DATE and start date of the FIRST DEFINITIVE TREATMENT PROVIDED.

5. If the patient is responsible for the delay in the start date of the treatment for any of these waiting time periods, the waiting time is calculated as the start date of the first treatment minus the CANCER REFERRAL DECISION DATE minus the sum of the three waiting time adjustments above.

Number of patients treated during the quarter NOT treated within two months (62 days).

5. This counts the number of PATIENTS where the number of days from the CANCER REFERRAL DECISION DATE to the date of the first definitive treatment is more that 62.

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QMCW CANCER WAITING TIMES MONITORING THE "TWO WEEK" TARGET

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Change to Diagram: change to aliases

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QMCW CANCER WAITING TIMES MONITORING THE "TWO WEEK" TARGET

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Change to Diagram: Change to diagram contents

 QMCW Cancer Waiting Times Monitoring the "Two Week" Target  QMCW Cancer Waiting Times Monitoring The Targets 

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e-mail: disp@nhsia.nhs.uk