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Testing testing testing

Testing for COVID-19 has had the most airtime in the last week. As we move through this pandemic the focus is now shifting to ensuring that we feel safe and exploring what steps can be taken to protect us when we attend any medical space. This is new territory for everyone so much of the work being done at the moment is in pilot phase. For services to return to pre-COVID levels, the key is testing and screening for COVID-19, which looks like it will be here to stay.

Over the coming weeks patients who need important planned procedures – including surgery – will begin to be scheduled for that care, with specialists prioritising those with the most urgent clinical need.

So if you are waiting for surgery or other treatment, you will be required to isolate for 14 days and be clear of any symptoms before being admitted. Testing will also be offered if you are waiting to be admitted to provide further certainty you are COVID-free. This will help to protect patients from potentially catching the virus in hospital, and help staff to ensure they are using the correct infection control measures and protective equipment.

If you need urgent or emergency care you’ll be tested on arrival and streamed accordingly, with services split to make the risk of picking up the virus in hospital as low as possible. Those attending emergency departments and other ‘walk-in’ services will be required to maintain social distancing, with trusts expected to make any adjustments necessary to allow this.

So what types of testing are available for COVID-19?

There are three broad types of tests:

  1. A lab-based test to see if you have the virus, known as the virus PCR test, also sometimes called amolecular or nucleic acid test
  2. A lab-based test to see if you have developed antibodies to the virus, known as an antibody test, also sometimes called a serologytest
  3. A rapid diagnostic test (RDT) or point-of-caretest to get quick results without needing to send the sample to a laboratory (different rapid diagnostic tests can be used to see whether the virus or antibodies are present)

The virus PCR test detects the presence of SARS-CoV-2. This requires a swab of your nose and throat which can be taken at home, testing centre, or hospital. This test is useful for identifying whether you are currently infected which is why it is recommended while you are experiencing symptoms. This is the test currently being made widely available by the NHS either as an at-home sampling kit or at regional drive-through centres.

The antibody test requires a sample of your blood (collected at home with a finger prick test, testing centre or hospital) and then sent to a laboratory to look for the presence of antibodies rather than the virus itself. Because it takes time for your immune system to make these antibodies, this test is best used to identify a past infection. This test may also be useful for those who have been infected but didn’t have symptoms or did not qualify for the virus PCR test.

The third type of testing that you may have heard of recently is rapid diagnostic tests (RDTs), also known as point-of-care tests. These are usually done in a doctor’s office and give results within minutes without the need to send the swab or blood sample to a laboratory. These tests can look either for virus antigens (rapid antigen test) to help diagnose current infection or antibodies (rapid antibody test) to determine a past infection. At present, the World Health Organisation recommends these tests only for research purposes but not for clinical decision making until more evidence on their validity and utility becomes available. Some companies have been illegally selling rapid diagnostic tests for at-home use. As it stands, there are no rapid diagnostic tests approved in the UK for at-home use.

There is still much that is unknown about COVID-19 and doctors and scientists are working hard to discover as much as they can as quickly as possible. Testing both for active infection with virus PCR swab tests, as well as previous infection with antibody blood tests, will play a very important role in our understanding of this disease and how to triage people in the future.

Up to date information on NHS testing can be found here.

 

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Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerous. Non-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php