Lung cancer care continues to improve eight years on from first national audit

Lung cancer patients in Great Britain are benefiting from improved treatment and care – including a higher rate of curative surgery – thanks in part to the continued commitment of clinical staff to a major national audit.

Data developed for the first time through the National Lung Cancer Audit has played a major part in helping healthcare organisations understand and improve the standard of care they offer and, ultimately, patient outcomes.

Eight years on from the first audit publication, today’s latest report is based on data for 38,500 patients first seen in 2011 in Great Britain. This represents about 93 per cent of new cases expected for this period and is thought to cover almost all cases of lung cancer presenting to secondary care.

The audit is managed by the Health and Social Care Information Centre in partnership with the Royal College of Physicians and commissioned by the Healthcare Quality Improvement Partnership.

Based on audit data for patients first seen in 2011, today’s report shows that in England and Wales:

Three in five patients (60 per cent) now have anti-cancer treatment such as chemotherapy or radiotherapy, compared to just fewer than half of patients first seen in 2005 (45 per cent).

One in five patients with confirmed non-small cell lung cancer (20 per cent) now has an operation that could potentially cure their cancer, compared to one in ten patients (10 per cent) first seen in 2005.
Just under 15 per cent of all patients diagnosed with lung cancer or mesothelioma now have an operation (either to try to cure them or to help prolong their life or alleviate symptoms) compared to less than one in ten (nine per cent) first seen in 2005.

Although surgical figures may appear low – they represent a significant improvement among the minority of lung cancer patients that potentially can be helped with surgery. The majority of patients present to hospital with very advanced cancer, meaning a curative operation is no longer a treatment option.

96.2 per cent of patients are now discussed by a specialist team of health professionals (known as a multidisciplinary team or an MDT) compared to 86 per cent of patients first seen in 2005. MDTs are seen as key to accurately assessing cases and determining the best course of treatment. Every single case (therefore 100 per cent) will never be seen by MDTs, as unfortunately some patients present to hospitals with very advanced cancer and die within a very short space of time.

Both the level and quality of data submissions to the audit have continued to increase each year, with today’s report including information for Scottish health boards and for the one trust in Guernsey.

In Scotland (considering about 4,700 patients in 2011 and 4,400 in 2010) 59.7 per cent of patients had anti-cancer treatment in 2011 compared to 63.9 per cent in 2010, while the proportion of patients overall who had surgery fell slightly from 11.1 per cent to 10.7 per cent. However, for patients with confirmed non-small cell lung cancer, the proportion having surgery increased from 16.3 per cent to 18.5 per cent.

While today’s report shows care across Great Britain has generally improved; variation remains between organisations that cannot be fully explained by either data quality or case-mix (the type of patient cohort an organisation cares for, such as the age, severity of illness and presence of other conditions in patients). For example, the inter-quartile variation8 in the proportion of patients first seen in 2011 in England and Wales that had an operation ranged from 11.0 per cent in one organisation to 16.5 per cent in another.

Although the level of audit data quality is now excellent for most organisations, the audit is urging all cancer networks and hospital trusts to take responsibility for their data and use it review and improve their local lung cancer services. The audit report contains a tool kit to help with this process.

Consultant in Respiratory Medicine Dr Mick Peake, audit clinical lead and clinical lead for NHS Cancer Improvement and the National Cancer Intelligence Network, said: “Collection of data is now embedded in lung cancer clinical teams in the UK. The overall quality of these data is now excellent and we believe that the very large part of the variation reported is a reflection of how things really are across the country. The performance of hospitals has improved consistently year on year over the period of the audit and this is making a really positive impact on patient care and outcomes. However, the level of variation that is shown means that there is still significant room for improvement to bring all hospitals up to the standard of the best.”

From December 5 the audit report can be accessed at

Case Study: Surgery rate doubles at Essex Cancer Network following audit-inspired change.

Through the use of audit information, staff at Essex Cancer Network found that the rate of lung cancer patients having surgery in their network was low, especially at Southend University Hospital NHS Foundation Trust.

This triggered a network-wide audit that saw several changes made to clinical practice. Ultimately, this led to the surgery rate doubling in the first six months of 2012, with this increase continuing in more recent months.

A major key to such an improvement involved enhanced work around staging – the process of assessing how far lung cancer has spread and reviewing a patient’s treatment options depending on their condition.

In one case for instance – clinicians used a range of necessary tests to ensure the correct diagnosis and staging of a patient who was referred to them with nodules on both lungs.

The complexity of the case meant if some of the tests had been used in isolation, they may have resulted in less effective diagnosis and staging than was actually achieved.

One nodule was found to be benign, but the other was diagnosed as cancerous and removed. Early diagnosis meant the cancer was relatively small, allowing curative surgery to take place and hugely improving the patient’s chance of long term survival.

The network has also introduced other changes. If a (PET) scan appears to show a patient’s cancer has spread beyond their lung, this is confirmed with a tissue biopsy. This reduces the potential for a scan image to show an apparent spread that in fact represents something else, such as an infection.

Lead clinicians also now meet radiology staff to plan staging, diagnostics and discuss CT scans.

Meanwhile every patient of borderline fitness for surgery is now seen by a cardiothoracic surgeon; and if a patient is judged unfit for surgery at a multidisciplinary team meeting, they are offered a second opinion if felt appropriate by the referring physician.

Signs and symptoms Lung Cancer

Symptoms that may suggest lung cancer include:

  • dyspnea (shortness of breath)
  • hemoptysis (coughing up blood)
  • chronic coughing or change in regular coughing pattern
  • wheezing
  • chest pain or pain in the abdomen
  • cachexia (weight loss), fatigue, and loss of appetite
  • dysphonia (hoarse voice)
  • clubbing of the fingernails (uncommon)
  • dysphagia (difficulty swallowing).

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