30-day mortality after systemic anti-cancer therapy (SACT)
Patients treated in 2022

About this release

This report by Public Health Scotland (PHS) is the first annual release of 30-day mortality after systemic anti-cancer therapy (SACT). It presents the number and percentage of patients who died within 30 days of starting their last cycle of SACT, reported for NHS Scotland and the three regional cancer networks. The data has been visualised in a dashboard available on the PHS website.

SACT drugs include cytotoxic chemotherapy, targeted therapies and immunotherapy. Hormone therapy is not included in this report. This publication includes all adult patients who were prescribed SACT in secondary care in Scotland in 2022, separated into 15 cancer types and 30 cancer sub-groups. All deaths occurring within 30 days of starting a treatment cycle are included in this report. These deaths may be directly due to the treatment received, but also deaths which were unrelated to treatment, due to disease progression, due to co-morbidities or for any other unrelated cause, were included. No adjustment has been made for case-mix.

Main points

Currently there are no targets set for SACT 30-day mortality. Results for the regional cancer networks have been compared with the results for Scotland overall to identify any variations across the country. Mortality may vary between types of cancer due to the behaviour of the disease, the treatments available and the decisions taken by oncologists and agreed by the patient.

• For NHS Scotland, the highest 30-day mortality was for cancers of unknown primary at 11.5%, with seven patients dying within 30 days of starting a SACT cycle out of the 61 patients treated. The lowest 30-day mortality was for cancers of the central nervous system at 2.2%, with nine patients dying out of the 404 patients treated.
• Among the most commonly treated cancers, those with more than 1,000 patients treated in 2022, the highest 30-day mortality was recorded for lung and chest cancer at 8.6%, with 200 patients dying within 30 days of starting a SACT cycle out of the 2,313 patients treated. The lowest 30-day mortality was breast cancer at 2.6%, with 115 patients dying within 30 days of starting a SACT cycle out of the 4,391 patients treated.

A chart with dots representing SACT 30-day mortality for NHS Scotland by cancer type. The number of patients treated for each cancer type is shown next to the chart.

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30-day mortality by cancer type for NHS Scotland

• For all types of cancer, there were no outliers for any regional cancer network which could indicate true variation in the quality of care delivered. Any observed differences between the regional cancer networks are explainable by chance.

Background

Guidance for the safe delivery of systemic anti-cancer therapy (DL (2023) 15) sets the framework for the safe delivery of SACT. The guidance includes clinical trials. Early phase trials, included in this report, often include patients with advanced cancer for whom no further standard therapy is available and choose to try new drugs in a carefully managed trial. It recognises the need to report and review all deaths occurring within 30 days of SACT administration, as part of NHS Board clinical governance arrangements.

Further information

The next release of this publication will be summer 2024.