Head and neck cancer Quality Performance Indicators
Patients diagnosed from April 2017 to March 2022, with follow-up to March 2023

About this release

This report by Public Health Scotland (PHS) is part a series of publications on cancer survival, using data from the Cancer Audit - Quality Performance Indicators (QPIs) dataset. This publication focuses on head and neck cancer patients diagnosed between April 2017 to March 2022, although reports for head and neck and oropharyngeal cancer use data for 2019 to 2022 for reasons explained in the Technical Report.

The main purpose of the report is to examine whether survival outcomes were equitable across the three regional cancer networks: North Cancer Alliance (NCA), South East Scotland Cancer Network (SCAN) and West of Scotland Cancer Network (WoSCAN).

Main points

For head and neck cancer (3,496 cases diagnosed between 1 April 2019 and 31 March 2022):

• Survival from all causes of death (including cancer) was 71% at one year after diagnosis and 55% at three years after diagnosis.
• Survival differed substantially between subsites, ranging from 26% for hypopharyngeal cancer at 3 years after diagnosis to 63% for oropharyngeal cancer.
• Survival from all causes of death differed between regional networks, with survival lowest in WoSCAN (3-year survival was 52% in WoSCAN and 58% in NCA and SCAN).
• Univariable analyses showed that those who were older, lived in a more deprived area, were less mobile or who were diagnosed at a later stage tended to have lower survival.
• After adjustment using statistical models, for age, sex, deprivation, cancer subsite and stage (as well as treatment, in one model), there remained a difference in all-cause mortality rates between networks. Statistical models cannot adjust for all factors that affect survival and differ between regional populations.
• Reassuringly, differences between networks were explainable at a subsite level.

For oropharyngeal cancer (1,141 cases diagnosed between 1 April 2019 and 31 March 2022):

• Survival from all causes of death differed between networks, with survival lowest in WoSCAN (3-year survival was 58% but was 65% in NCA and 69% in SCAN).
• Univariable analyses showed that those who were older, lived in a more deprived area, were less mobile, were diagnosed at a later stage or who tested negative for a protein called "P16" tended to have lower survival. The protein P16 can be used as a proxy for the presence of human papillomavirus (HPV), with HPV-associated tumours having a better prognosis than other oropharyngeal cancers.
• When adjusting, using statistical models, for age, sex, deprivation and stage, there remained a difference in all-cause mortality rates between networks. However, when 'P16 status', which is also loosely correlated with alcohol and smoking behaviours, was added to the model, there was no difference in mortality rates between networks. This suggests there are no major differences between networks in survival outcomes.

Finally, there was no difference in survival between the networks for cancers of the oral cavity, hypopharyngeal cancer, laryngeal cancer, or the rarer cancer sites grouped together into "other sites" (cases diagnosed between 1 April 2017 and 31 March 2022).

A Clinical Commentary has been provided alongside these results to aid interpretation and detail actions being undertaken to address the observed inequalities.

Background

This report was initially released to clinicians as Management Information in December 2023.

Data are from the Cancer Audit-QPIs dataset that underpins the National Cancer Quality Programme's quality performance indicators, which are used to support continuous improvement in cancer care. NHS Boards are required to report these indicators against a clinically agreed indicator-specific target as part of the mandatory National Cancer Quality Programme.

Note the data reported are not directly comparable to those reported by the Scottish Cancer Registry in PHS as only patients who receive definitive cancer treatment within NHS Scotland will be included in the QPIs dataset, unlike the SCR data which includes all patients diagnosed within Scotland, providing population-based incidence data.

As a result of this, the cancer survival figures reported here for the cancer QPIs are not directly comparable to the overall population-based survival statistics routinely reported by PHS.

Publication

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