Results from the National Lung Cancer Audit (NLCA) published today show that a substantial number of patients are needlessly dying of lung cancer as a result of local variation in care. While some patients may not be eligible or able to have surgery but can receive radiotherapy, surgical treatment represents the best chance of cure of the disease. However, the proportion of patients with early stage lung cancer who receive surgery varies from 33% to 63% when measured at network level (with even greater variation at trust level).
The audit collected data on 39,203 patients in Great Britain for this audit period, representing all patients attending or admitted to hospital with lung cancer.
Overall measures of the standards of care have been sustained and in some areas have marginally improved compared to previous years, with very small rises in the proportion of patients having their cancer subtyped, the proportion of patients with small cell lung cancer receiving chemotherapy (67.9% to 69.7%), and in the proportion having access to a lung cancer nurse specialist (LCNS) (82.3% to 83.9%).
Despite these improvements, there remains marked variation across trusts and networks and differences in case-mix do not appear to explain the whole of this variation. In addition to the variation in the provision of surgery, a similar picture emerges for fitter patients who have advanced and incurable disease – in this group chemotherapy is known to extend life expectancy and improve quality of life, yet treatment rates vary 48% to 69% across the networks.
Ensuring that all organisations provide the same standard of care as that provided in the best performing units is likely to cure more patients, and improve quality of life for those patients who cannot be cured. Trusts are encouraged to critically appraise their own results and perform reviews of lung cancer pathways and/or clinical cases where investigation or treatment rates are below the national average.
Dr Ian Woolhouse, co-clinical lead NLCA, said:
Whilst there have been important improvements in a number of areas of lung cancer care, this annual report demonstrates that there is still some way to go to reduce variation in key treatments such as lung cancer surgery which is likely to have the biggest impact on survival.
Dr Mick Peake, clinical lead, National Lung Cancer Audit, said:
Over the ten years of the National Lung Cancer Audit we have definitely seen improvements in the standards of care for lung cancer patients and these are now leading to improvements in survival. However, it is clear that not every patient in every area of the country is receiving optimal care, so our job is not yet done.
A full copy of the report is available under embargo. For a copy and to arrange interviews please contact Linda Cuthbertson, head of PR, on 0203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk
About HQIP, the National Clinical Audit Programme and how it is funded.
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). NCAPOP is funded by NHS England, Welsh Government and with some individual audits also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.