Information Specification

The data items required for National Cancer Data Standards for Wales – Acute Oncology Service (AOS) and their equivalent labels in COSD V9.0, where there is an equivalent, are listed below.

This Standard should be completed for all acute oncology patients that present within the hospital or health board setting, each time of presentation. Explicitly, information within this Standard would be required where the Core data item Acute Oncology Assessment Date is populated with a date and reflects that an acute oncology assessment has taken place.

Where the specification cites NHS Wales Data Dictionary, please refer to the Dictionary for the relevant guidance i.e. definition, format, or code list.

For consistency, all dates listed in the Specification are standardised as ccyymmdd.

Where D is denoted in Status, this indicates that the information should be derived from another data item. This typically occurs with data items that are simply text representations of their code counterparts. Other Status codes are M (Mandatory), R (Required) – the data item should be recorded where applicable and O (Optional).

Core data items should be collected for all cancers. To reduce replication of information, Core data items have not been listed in this patient group specific Standard and users should refer to National Cancer Data Standards for Wales 1. National Cancer Data Set - Full list DSCNs.xlsx (live.com) for a list of Core requirements. However, in some cases, the site/patient group specific application of Core data items may differ e.g. a particular site/patient group may require additional or fewer codes to those already published in Core, or perhaps have additional business rules as to how the Core data item should be coded. Where this occurs, the Core data item will be replicated in the site/patient group specific Standard with the respective additional site/patient group specific detail. These are flagged in the following table with an * next to the data item name.

For data items used in the National Cancer Data Standards for Wales that already exist within the NHS Wales Data Dictionary. These data items have been flagged with an † next to the data item name, as whilst this introduces a change to an existing information standard, the immediate use of this mandate will be used as a framework for the development of the CIS, therefore service/data providers should continue with ‘business as usual’ in terms of the data being collected and reported.

Reporting Data Item	Definition	Format	Code List (Code)	Code List (Text)	Status	COSD
Presentation Details. To be completed for all, in conjunction with one or more presentation types
Organisation Code (Initial Acute Presentation)	An identifier code to identify the Health Board or Trust of where the patient’s initial acute presentation occurred	See Organisation Code - LHB/Trust Site Code	N/A	N/A	R	N/A
Organisation Site Code (Initial Acute Presentation)	An identifier site code to identify the organisation within the Health Board/Trust of where the patient’s initial acute presentation occurred	See Organisation Code - LHB/Trust Site Code	N/A	N/A	R	N/A
Date of Initial Acute Presentation	Record the date that the initial acute presentation to the Health Board/Trust occurred	ccyymmdd	N/A	N/A	R	N/A
Time of Initial Acute Presentation	Record the time that the initial acute presentation to the Health Board/Trust occurred	24 hr hh:mm	N/A	N/A	R	N/A
Acute Oncology Presentation Type	Record the presentation type for the patient (Multiple options can be chosen)	Code List	01	Complication of Cancer	R	N/A
			02	Complication of Cancer Treatment
			03	New Diagnosis of Cancer
			04	Unrelated to Cancer Diagnosis
Patient Type*	Record the type each patient presentation is grouped within. (Multiple options can be chosen) Note: i. Of the adjacent codes, MUO/CUP (Malignancy Unknown Origin/Cancer Unknown Primary), Treatment Complication - Immunotherapy Toxicity Details and Treatment Complication - Other are not present in Core. These have been added here to provide greater granularity. ii. The information recorded here will determine the collection of additional information in proceeding sections as follows: Sepsis Details will be required if Suspected or Confirmed Neutropenic Sepsis is selected. Metastatic Spinal Cord Compression (MSCC) Details will be required if Suspected or Confirmed Metastatic Spinal Cord Compression (MSCC) is selected. Malignancy of Undefined Primary Origin (MUO)/Carcinoma Unknown Primary (CUP) Details will be required if MUO/CUP (Malignancy Unknown Origin/Cancer Unknown Primary) is selected. Immunotherapy Toxicity Details will be required if Treatment Complication - Immunotherapy Toxicity is selected Other Disease Complications Details will be required where Cancer Complication, Cancer Recurrence/Progression (Local or Regional), Cancer Recurrence/Progression (Distant), Cancer Transformation, Comorbidity Complications or Other are selected.	Code List	01	New Presentation	R	Patient Type (CR8730)
			03	Suspected or Confirmed Neutropenic Sepsis
			04	Cancer Complication
			05	Cancer Recurrence/Progression (Local or Regional)
			06	Cancer Recurrence/Progression (Distant)
			07	Cancer Transformation
			08	Suspected or Confirmed Metastatic Spinal Cord Compression (MSCC)
			09	Comorbidity Complications
			81	MUO/CUP (Malignancy Unknown Origin/Cancer Unknown Primary)
			82	Treatment Complication - Immunotherapy Toxicity
			83	Treatment Complication - Other
			98	Other
Sepsis Details
Date of recognition of suspected sepsis	Record the date of onset of the recognition of suspected sepsis This is at point of triage/first set of observations	ccyymmdd	N/A	N/A	R	N/A
Time of recognition of suspected sepsis	Record the time of the onset of the recognition of suspected sepsis This is the time the patient was assessed within triage/first set of observations taken	24 hr hh:mm	N/A	N/A	R	N/A
Date of first clinical review	Record the date the first clinical review by a Senior Practitioner took place within the Health Board/Organisation	ccyymmdd	N/A	N/A	R	N/A
Time of first clinical review	Record the time the first clinical review by a Senior Practitioner took place within the Health Board/Organisation	24 hr hh:mm	N/A	N/A	R	N/A
Date IV Antibiotics administered	Record the date the iv antibiotics were administered	ccyymmdd	N/A	N/A	R	N/A
Time IV Antibiotics were administered	Record the time the iv antibiotics were administered	24 hr hh:mm	N/A	N/A	R	N/A
Lactate Undertaken	Has a Lactate test been undertaken	Code List	01	Yes	R	N/A
Lactate Undertaken	Has a Lactate test been undertaken	Code List	02	No	R	N/A
Lactate Undertaken within 1 Hour	Has the Lactate test been undertaken within 1 hour from the time of recognition of suspected sepsis	Code List	01	Yes	R	N/A
Lactate Undertaken within 1 Hour		Code List	02	No	R	N/A
Blood Cultures Undertaken	Has all Blood Cultures been undertaken	Code List	01	Yes	R	N/A
Blood Cultures Undertaken	Has all Blood Cultures been undertaken	Code List	02	No	R	N/A
Antibiotics Prescribed as per Sepsis Policy	Record if antibiotics were prescribed in line with the sepsis policy	Code List	01	Yes	R	N/A
Antibiotics Prescribed as per Sepsis Policy		Code List	02	No	R	N/A
Neutropenic Sepsis Confirmed	Record if neutropenic sepsis was confirmed	Code List	01	Yes	R	N/A
Neutropenic Sepsis Confirmed	Record if neutropenic sepsis was confirmed	Code List	02	No	R	N/A
Mortality from Sepsis within 30 days	Record if death occurred from sepsis within 30 days	Code List	01	Yes	R	N/A
Mortality from Sepsis within 30 days	Record if death occurred from sepsis within 30 days	Code List	02	No	R	N/A
Compliance with Sepsis 6 Actions within 1 hour	Record if compliant with Sepsis 6 actions within one hour as per guidelines Sepsis 6 consists of three diagnostic and three therapeutic steps all to be delivered within one hour of the initial diagnosis of sepsis: (1) Tritrate oxygen to a saturation target of 94% (2) Take blood cultures and consider source control (3) Administer empiric intravenous antibiotics (4) Measure serial serum lactates (5) Start intravenous fluid resuscitation (6) Commence accurate urine output measurements	Code List	01	Yes	R	N/A
			02	No
			08	Not appropriate
Metastatic Spinal Cord Compression (MSCC) Details
Date of suspicion of MSCC	Record the date of onset of suspected MSCC This is the date of the first clinical documentation of suspicion	ccyymmdd	N/A	N/A	R	N/A
Time of suspicion of MSCC	Record the time of the onset of suspected MSCC This is the time of the first clinical documentation of suspicion	24 hr hh:mm	N/A	N/A	R	N/A
Date of Whole Spine MRI	Record the date of the whole spine MRI following the suspicion of MSCC	ccyymmdd	N/A	N/A	R	N/A
Time of Whole Spine MRI	Record the time of the whole spine MRI following the suspicion of MSCC	24 hr hh:mm	N/A	N/A	R	N/A
Date Whole Spine MRI Reported	Record the date the whole spine MRI was reported	ccyymmdd	N/A	N/A	R	N/A
Time Whole Spine MRI Reported	Record the time the whole spine MRI was reported, if available	24 hr hh:mm	N/A	N/A	O	N/A
Whole Spine MRI Result	Record the result of the whole spine MRI.	Code List	01	MSCC confirmed	R	N/A
			02	MSCC not confirmed
			03	Spinal Mets
			04	Neither (No MSCC or Spinal Mets confirmed)
Steroids Commenced	Record if the patient was commenced on steroids. If the patient was commenced on steroids select Yes. Where the patient was not commenced on steroids, provide the reason for that by selecting Contra-indicated for Medical Reasons, Lymphoma, Not Considered by Medical/Clinical Team or Patient Declined	Code List	01	Yes	R	N/A
			02	No - Contra-indicated for Medical Reasons
			03	No - Lymphoma
			04	No - Not Considered by Medical/Clinical Team
			05	No - Patient Declined
Low Molecular Weight Heparin (LMWH) Commenced	Record if the patient was commenced on Low Molecular Weight Heparin (LMWH)	Code List	01	Yes	R	N/A
			02	No
			08	Not Appropriate
Date referred to Physiotherapy	Record the date the patient was referred to Physiotherapy	ccyymmdd	N/A	N/A	R	N/A
Date seen by Physiotherapy	Record the date the patient was seen by Physiotherapy	ccyymmdd	N/A	N/A	R	N/A
Tokuhashi Score	Specify the Tokuhashi Prognostic Score range	Code List	01	0-8; Survival <6 months	R	N/A
			02	9-11; Survival 6-12 months
			03	12-15; >1 year
Date of Treatment Plan	Record the date of the treatment plan, determined by a member of the MDT	ccyymmdd	N/A	N/A	R	N/A
Time of Treatment Plan	Record the time of the treatment plan, determined by a member of the MDT	24 hr hh:mm	N/A	N/A	R	N/A
Treatment Plan	Specify the plan of treatment for the patient, determined by a member of the MDT	Code List	01	Surgery	R	N/A
			02	Radiotherapy
			03	Best Supportive Care
Date Referred for Surgical Opinion	Record the date the patient was referred for Surgical Opinion Note: Only for completion when Treatment Plan is recorded as Surgery	ccyymmdd	N/A	N/A	R	N/A
Time Referred for Surgical Opinion	Record the time the patient was referred for Surgical Opinion Note: Only for completion when Treatment Plan is recorded as Surgery	24 hr hh:mm	N/A	N/A	R	N/A
Date Surgical Opinion Given	Record the date the Surgical Opinion was given Note: Only for completion when Treatment Plan is recorded as Surgery	ccyymmdd	N/A	N/A	R	N/A
Time Surgical Opinion Given	Record the time the Surgical Opinion was given Note: Only for completion when Treatment Plan is recorded as Surgery	24 hr hh:mm	N/A	N/A	R	N/A
Date Of Surgery	Record the date the Surgery was undertaken Note: Only for completion when Treatment Plan is recorded as Surgery	ccyymmdd	N/A	N/A	R	N/A
Date Of Radiotherapy	Record the date the Radiotherapy commenced Note: Only for completion when Treatment Plan is recorded as Radiotherapy	ccyymmdd	N/A	N/A	R	N/A
Date Of Best Supportive Care	Record the date that the treatment of Best Supportive Care (BSC) commenced Note: Only for completion when Treatment Plan is recorded as Best Supportive Care	ccyymmdd	N/A	N/A	R	N/A
Treatment within 24 hours	Record if treatment commenced within 24 hours of MSCC being confirmed. Note: i. Only for completion when Whole Spine MRI Result is recorded as MSCC Confirmed ii. The response will be based on the time difference between the information recorded for Date Whole Spine MRI Reported/Time Whole Spine MRI Reported and Date of Treatment Plan/Time of Treatment Plan. As time information may not always be available, the Yes response may reflect an approximate 24 hrs calculation where it is based on date information only.	Code List	01	Yes	R	N/A
Treatment within 24 hours		Code List	02	No	R	N/A
Malignancy of Undefined Primary Origin (MUO)/Carcinoma Unknown Primary (CUP) Details
Date of suspicion of MUO/CUP	Record the date of suspected MUO/CUP	ccyymmdd	N/A	N/A	R	N/A
Was the patient discussed at a Multi-disciplinary meeting (MDT)?	Specify if the patient was discussed at a MDT meeting?	Code List	01	Yes	R	N/A
			02	No
			08	Not Appropriate
Date of First MDT Discussion	Specify the date the patient was first discussed at a MDT meeting Note: Only for completion when Was the patient discussed at a Multi-disciplinary meeting (MDT)? Is recorded as Yes	ccyymmdd	N/A	N/A	R	N/A
Number of different MDT specialties that patient discussed in	Specify the number of different MDT specialties that the patient was discussed in, this includes specific MUO/CUP MDTs. E.g. if discussed at a Breast MDT, Gynae MDT and MUO MDT, then this should be recorded as 3 Note: Only for completion when Was the patient discussed at a Multi-disciplinary meeting (MDT)? Is recorded as Yes	max an2	N/A	N/A	R	N/A
Diagnosis	Specify the confirmed diagnosis Note: If the patient dies before a clear diagnosis is made it remains an MUO	Code List	01	Benign	R	N/A
			02	MUO (Malignancy of Undefined Primary Origin) - No Biopsy Available
			03	Confirmed CUP (cCUP - Confirmed Carcinoma Unknown Primary)
			04	Tumour Site Identified (Solid Tumours) - Site Specific Origin Confirmed
			05	Non-Epithelial or Haematological Malignancy (e.g., Sarcoma, Lymphoma, Germ Cell Tumour etc)
Discussed at MUO/CUP MDT	Record if the patient was discussed in a specific MUO/CUP MDT?	Code List	01	Yes	R	N/A
Discussed at MUO/CUP MDT		Code List	02	No	R	N/A
Staff Role Carrying out the Keyworker Role	Record the type of Keyworker assigned to the patient	Code List	01	AOS Nurse Practitioner	R	N/A
Staff Role Carrying out the Keyworker Role	Record the type of Keyworker assigned to the patient	Code List	02	CUP Specialist Nurse	R	N/A
Immunotherapy Toxicity Details. This section relates to Checkpoint Inhibitors Only
Date immunotherapy treatment complication suspected (onset of immunotherapy complication)	Record the date of the suspected/onset of the immunotherapy complication	ccyymmdd	N/A	N/A	R	N/A
Start of Repeating Data Items. Multiple occurrences of this item are permitted. Record the date, grade and complication experienced for the following data items e.g., if 3 complications experienced need to record date, grade and complication for each one separately
Date of Immunotherapy Toxicity	Record the date the Immunotherapy toxicity experienced is clinically recorded	ccyymmdd	N/A	N/A	R
Grade of Immunotherapy Toxicity	Record the grade of the Immunotherapy toxicity Note: Only for completion where Date of Immunotherapy Toxicity is recorded	Code List	1	Grade I	R	N/A
			2	Grade II
			3	Grade III
			4	Grade IV
Immunotherapy Complication	Specify the immunotherapy complication experienced Note: Only for completion where Date of Immunotherapy Toxicity is recorded	Code List	01	Diarrhoea/Colitis	R	N/A
			02	Hepatitis
			03	Endocrine
			04	Dermatitis
			05	Pneumonitis
			06	Nephritis
			07	Neurological
			08	Cardiac
			97	Other
Immunotherapy Complication - Other	Provide detail of the 'other' immunotherapy complication experienced. Note: Only for completion when Immunotherapy Complication is recorded as Other	max an50	N/A	N/A	R	N/A
End of Repeating Data Items
Start of Repeating Data Items. Multiple occurrences of this item are permitted
Was the patient referred to a Non-Cancer Specialist	Specify if the patient was referred to a Non-Cancer Specialist	Code List	01	Yes	R	N/A
			02	No
			08	Not Appropriate
Specialty Type of Non-Cancer Specialist Referred to	Specify the specialty type of the non cancer specialist the patient was referred to Note: Only required for completion where Was the patient referred to a Non-Cancer Specialist recorded as Yes	Code List	01	Gastroenterology	R	N/A
			02	Respiratory
			03	Endocrinology
			04	Dermatology
			05	Other
Date referred to Non-Cancer Specialist	Record the date referred to the Non-Cancer Specialist Note: Only required for completion where Was the patient referred to a Non-Cancer Specialist recorded as Yes	ccyymmdd	N/A	N/A	O	N/A
Date toxicity related treatment started	Record the date that the treatment for the immunotherapy toxicity/complication started	ccyymmdd	N/A	N/A	R	N/A
End of Repeating Data Items
Other Disease Complications Details
Start of Repeating Data Items. Multiple occurrences of this item are permitted. Add each Disease Complication separately
Disease Complication that resulted in Presentation	Specify the complication/toxicity that caused the reason for presentation	Code List	01	AKI	R	N/A
			02	Anaemia
			03	Ascites
			04	Bleeding
			05	Brain Mets
			06	Cancer Associated Thrombosis (CAT)
			07	Disease Progression
			08	Dyspnoea
			09	Fatigue/Frailty/Generally Unwell
			10	Fall
			11	Fracture
			12	Infection
			13	GI Symptoms (inc bowel obstruction)
			14	Hypercalcaemia
			15	Jaundice
			16	Neurosensory
			17	Pain
			18	Pleural Effusion
			19	Social
			20	Supra Vena Cava Obstruction (SVCO)
			97	Other
Disease Complication that resulted in Presentation - Other	If Other is recorded, specify the other type of disease complication that caused the reason for presentation	max an50	N/A	N/A	R	N/A
End of Repeating Data Items