Kidney cancer

  • Quality standard
  • QS215
  • Published: 
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Quality statement 5: Follow-up imaging

Quality statement

Adults with localised or locally advanced renal cell carcinoma (RCC) who have finished treatment have follow-up imaging, with results reported to their clinical team within 4 weeks of each scan.

Rationale

It is important that the results of follow-up imaging after treatment for localised or locally advanced RCC are shared with the person with RCC as soon as possible. Reporting the results of follow-up imaging to the clinical team within 4 weeks of each scan facilitates this. Agreeing a follow-up plan, that includes the follow-up imaging schedule, with the person with RCC who has finished treatment may help to manage their expectations and any anxiety. Follow-up imaging after treatment for localised or locally advanced RCC supports early detection and treatment for any local recurrence or distant metastases.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of adults with localised or locally advanced RCC who finish treatment who have an agreed follow-up plan that includes the follow-up imaging schedule.

Numerator – the number in the denominator who have an agreed follow-up plan that includes the follow-up imaging schedule.

Denominator – the number of adults with localised or locally advanced RCC who finish treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of follow-up imaging results for adults with localised or locally advanced RCC who have finished treatment that are reported to the clinical team within 4 weeks.

Numerator – the number in the denominator that are reported to the clinical team within 4 weeks.

Denominator – the number of follow-up imaging results for adults with localised or locally advanced RCC who have finished treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. NHS England's Diagnostic Imaging Dataset includes data on the overall report turnaround times for different types of imaging.

Outcome

Five-year survival rate for adults with localised or locally advanced RCC who have finished treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. NHS England's Cancer survival in England (adult cancer survival tables for people aged 15 to 99) includes data on 5-year survival for all people with kidney cancer.

What the quality statement means for different audiences

Service providers (such as secondary care, tertiary care and imaging services) ensure that systems are in place for adults with localised or locally advanced RCC who finish treatment to have follow-up imaging. Providers monitor whether imaging results are reported to the person's clinical team within 4 weeks of each scan.

Healthcare professionals (such as doctors, clinical nurse specialists and radiographers) agree a follow-up plan with adults who have finished treatment for localised or locally advanced RCC and ensure that imaging appointments are offered in line with the plan. They report imaging results within 4 weeks of each scan and share the results with adults with localised or locally advanced RCC as soon as possible once the results have been received.

Commissioners ensure that services provide follow-up imaging to adults who finish treatment for localised or locally advanced RCC and provide results to the clinical teams within 4 weeks.

Adults with localised or locally advanced RCC who have finished treatment have regular scans to check for signs that the cancer has returned or spread. Scans are reported to the adult's clinical team within 4 weeks of each scan being done. Adults discuss the results of each scan with their healthcare professional as soon as possible after the healthcare professional receives the results.

Source guidance

Definitions of terms used in this quality statement

Finished treatment

All planned treatment for localised or locally advanced RCC is complete, including any adjuvant treatment. [NICE's guideline on kidney cancer, recommendation 1.11.1]

Follow-up imaging

Adults who have had treatment for localised or locally advanced RCC should be offered contrast-enhanced CT (CECT) of the chest, abdomen and pelvis at regular intervals to detect recurrence.

If CECT should be avoided to reduce radiation exposure, both of the following should be offered:

  • MRI (with or without contrast) of the abdomen and pelvis, and

  • CT (without contrast) of the chest (unless the person cannot have CT).

If CECT should be avoided because the contrast agent is contraindicated, either of the following should be offered:

  • CT (without contrast) of the chest and MRI (with or without contrast) of the abdomen and pelvis, or

  • CT (without contrast) of the chest, abdomen and pelvis.

The agreed follow-up imaging schedule and the expected duration of follow-up, if there remains no sign of recurrence, should be included in the personalised care plan. [NICE's guideline on kidney cancer, recommendations 1.11.2 and 1.11.6 to 1.11.8]

Equality and diversity considerations

Adults diagnosed with RCC at a young age, especially those with a heritable RCC predisposition syndrome, may need follow-up imaging for long or repeated periods over their lifetime. They will face cumulative risks from any imaging, such as radiation from CT. Healthcare professionals should think about this when choosing imaging type and developing a follow-up plan.

Follow-up imaging may need to be delayed, or a different type of imaging may need to be used, for adults who are pregnant.

Adults should be made aware that they may be eligible for the NHS healthcare travel costs scheme.