Make COSD Work For You: Better Cancer Referrals with Technology That Works
By Dr. Amar S. Bhogal
The Cancer Outcomes and Services Dataset (COSD) is the national standard for reporting cancer in the NHS in England. It is a vital tool that supports cancer registration, research, service evaluation, and commissioning, offering a robust source of structured data on patient pathways, diagnosis, treatment, and outcomes [1].
COSD is more than just a compliance requirement—it is a critical driver for improving cancer care across the UK. The quality and consistency of COSD data can directly affect national cancer statistics, policy planning, and ultimately, patient outcomes. However, as highlighted in the insightful article "Apples and Pears" [2], while COSD contains a wealth of information, the richness of its data is often under-used due to inconsistent reporting practices and administrative burdens faced by frontline staff.
The Problem: Variation and Administrative Overload
Despite COSD's importance, data collection remains uneven. A comparison with tools like the Somerset Cancer Register [3] and Civica’s Clinical Pathways software [4] shows varying capabilities across trusts in terms of automation, data validation, and integration into existing workflows. While Somerset provides tailored oncology dashboards and Civica offers real-time patient tracking, both still depend heavily on manual input or disparate IT systems that risk duplication and inefficiency. For example, the Somerset data reporting system asks about frailty or fitness for surgery three times but only uses one field (or that is our understanding).
This inconsistency affects data fields critical for patient stratification and research—such as performance status, which has been shown to be poorly recorded in COSD compared to local or bespoke registries [5]. This gap has real-world implications: performance status is a key predictor of treatment tolerance and outcomes, and its absence reduces the clinical value of aggregated data. Are the data we collect too simplified? Or can we create a database combining simple assessments with biomarkers of muscle mass, cardiac function, BMI or weight, renal and liver function and parenclitic analysis to create formidable tools that are easy to use in day-to-day clinical practice.
The Solution: ONE Referral with Rich Data
Salutare’s ONE Referral [6] digitises the MDT referral process and captures structured data at the point of entry, the system ensures that all necessary COSD fields—including performance status—are not only recorded but exported in a format compatible with the national COSD submission requirements.
In a single digital referral, Salutare can:
Automatically extract and structure data needed for COSD
Improve consistency in key fields like performance status
Reduce manual data entry and admin burden for clinical teams
Enable faster, cleaner, and more accurate reporting for audits and research
In doing so, it supports a vision where software works for clinicians, not the other way around.
In the future, ONE Referral will capture real world data of biomarkers of muscle mass, cardiac, renal and liver status so that real-time parenclitic analysis gives accurate predictions of surgical risk and outcomes.
Conclusion
High-quality, consistent COSD reporting is essential for understanding and improving cancer outcomes in the UK. But the system only works as well as the tools that support it. Comparing current solutions highlights the variability and complexity involved.
Salutare offers a unified, simple solution that integrates with existing clinical pathways while lightening the administrative load—allowing clinicians to focus on care and researchers to work with richer, more reliable data.
In the world of cancer care, better data can lead to better outcomes.
References
NHS Digital. Cancer Outcomes and Services Dataset (COSD) [Internet]. NHS Digital. [cited 2025 Apr 16]. Available from: https://digital.nhs.uk/ndrs/data/data-sets/cosd
Apples and Pears. [Link provided by author]
Somerset NHS Foundation Trust. Somerset Cancer Register [Internet]. [cited 2025 Apr 16]. Available from: https://www.somersetft.nhs.uk/somerset-cancer-register/
Civica. Clinical Pathways Software [Internet]. [cited 2025 Apr 16]. Available from: https://www.civica.com/en-gb/product-pages/clinical-pathways-software/
Gatenby P, et al. Performance status recording in cancer patients: How good are we? Br J Cancer. 2017;117(7):921–924. doi:10.1038/bjc.2017.233
Salutare. Digital MDT Referral Platform [Internet]. [cited 2025 Apr 16]. Available from: https://www.salutare.co.uk
About the Author
Dr. Amar S. Bhogal is a junior doctor in the United Kingdom, dedicated to enhancing patient outcomes through the integration of advanced healthcare technologies. He has a robust background in medical research, having served as a Research Assistant at University College London's Institute for Liver and Digestive Health. His work has been pivotal in exploring the application of remote technology to support acute inpatient and transitional care, particularly for individuals with chronic obstructive pulmonary disease (COPD).
Beyond clinical medicine, Dr. Bhogal has held leadership roles in both the publishing and education sectors. He worked with Elsevier as a commissioning and managing editor for oncology journals, playing a key role in curating and advancing high-impact scientific research. Additionally, he served as a director for an educational startup focused on supporting children from disadvantaged backgrounds, demonstrating his commitment to widening access to education and fostering opportunities for young learners.
Passionate about the transformative potential of healthcare technologies, Dr. Bhogal is focused on leveraging innovative solutions to improve clinical practices and patient care.
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