The report, commissioned by the Healthcare Quality Improvement Partnership (HQIP), further highlights a significant rise in the proportion of patients with advanced non small-cell lung cancer (NSCLC) who received chemotherapy, by 16% from 48% in 2008 to 64% in 2015 and the percentage of NSCLC patients undergoing surgery has risen to 16.8%.
In order to ensure that all appropriate treatment options can be considered, a diagnosis must be confirmed by a laboratory pathologist (a process known as pathological confirmation). It is also recommended that further sub-classification is carried out, to collect more specific information about the exact type and stage of cancer, and the numbers of cells affected.
The number of cases with a pathological confirmation has seen an uplift to 72% from 69% in the previous year’s report, with the number of cases where the subtype could not be determined falling to 11%, meeting the target of 15% and continuing the historical trend seen over the past few years.
The clear increase in one year survival, rising from 31% to 38% in the five-year period from 2010 to 2015, reinforces the findings of the clinical outcomes and mesothelioma reports, also published by the National Lung Cancer Audit at the end of 2016.
Due to a change in the way data are collected in England, using the National Cancer Registration and Analysis Service (NCRAS), over 6000 further cases of lung cancer were able to be identified and included within the audit. As a result, this has provided the most comprehensive picture of lung cancer care in the UK to date.
Despite the obvious good news, as previous reports from the NLCA have shown, there continues to be regional variation in the survival rates and types of treatments that patients are offered. Work must therefore be done to ensure that all patients are consistently provided with the best possible care.
The recommendations in this report set out a vision for healthcare professionals, managers, chief executives and commissioners. These relate to three main areas: data completeness, process of care, and treatment and outcomes, all aimed at supporting lung cancer services to continue in improving care on a regional and national level.
Key recommendations include:
- Pathological confirmations below 80% should be reviewed to ensure that best practice has been followed.
- At least 90% of all patients should be seen by a Lung Cancer Nurse Specialist (LCNS), and 80% of patients should also have an LCNS present at the time of diagnosis (The report indicates that only 57% of patients were seen by a LCNS.)
MDTs with 1 year survival rates of less than 38% should review their diagnostic and treatment pathways to ensure that all patients are diagnosed promptly and treated appropriately.
Ian Woolhouse, NLCA senior clinical lead said: "It is very encouraging to note that overall many of our audit indicators have improved compared to the last report. Highlights include the improvement in pathological sub-typing of lung cancer, the use of chemotherapy and surgery in non-small cell lung cancer, and probably most importantly the improvement in one-year survival. However, there is still much work to do to ensure that all lung cancer patients receive a standard of care that is equal to the best in the country and we implore all lung cancer units to critically review their results and work with our quality improvement team to achieve this.
Dr Jesme Fox, Medical Director of Roy Castle Lung Cancer Foundation, said: "The NLCA is a great source of information on lung cancer. It is really important that we monitor services and lung cancer patient outcomes, in a timely manner. This audit allows us to do that. We are pleased to see this encouraging increase in patient survival. However, there is much still to do, to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care."