Lung cancer patients receiving better care as UK narrows gap on leading countries

7 December 2011      National Lung Cancer Audit release

UK countries are improving the quality of care they give to lung cancer patients and closing on the standard set by leading Western European nations, according to one of the word's most comprehensive audits.

The National Lung Cancer Audit - commissioned by HQIP and managed by The NHS Information Centre in partnership with the Royal College of Physicians - today shows the percentage of patients receiving key care measures, such as surgery or anti-cancer treatment like chemotherapy or radiotherapy, is improving each year.

Read the full report here >>

This means the gap between the UK and other countries in Western Europe, who have historically been rated as having higher quality care, is narrowing; while in the UK itself the margin between the highest and lowest performing providers has also reduced in a positive direction.

Lung cancer kills more people in the UK each year compared to any other form of cancer. The audit contains data for almost 100 per cent of the estimated 38,057 UK cases first treated in 2010 that presented to secondary care; a participation level thought to unprecedented for any other audit in the world.

The audit shows that for key treatment measures in 2010:

Surgery

• 13.7 per cent of patients in England and Wales and 11.7 per cent of patients in Scotland received an operation, compared to 10.8 per cent and 10.6 per cent respectively in 2008 (note 4).
• Lung cancer is often diagnosed at an advanced stage, meaning up to three quarters of patients are not suitable for surgery. The improved surgery rate suggests improving expertise among clinical teams to assess patients of borderline fitness for surgery, and better access to more complex surgical techniques often needed in such situations.
• It is difficult to draw exact comparisons between the UK and other countries as most have differing forms of data. However, available information suggests UK surgery rates, although improving, are still lower than in other countries:

            Italy - 25 per cent (note 5)   Sweden - 17.5 per cent (note 6) 

            USA - 27 per cent (note 7)     Holland - 20 per cent (note 8)

Anti-cancer treatment (surgery, chemotherapy and radiotherapy)

• 58.4 per cent of patients in England and Wales and 63.9 per cent of patients in Scotland received an anti-cancer treatment, compared to 54.0 per cent and 64.1 per cent respectively in 2008.
• Not all patients will be suitable for anti-cancer treatments, as for some the disease will be of a very advanced stage.
• Although international comparisons are limited; data for Sweden suggests about 66 per cent of patients receive anti-cancer treatment (note 6).

Histological/cytological diagnosis (tissue biopsy)

• 76 per cent of patients in England and Wales and 77.1 per cent of patients in Scotland received a histological or cytological diagnosis, compared to 72.2 per cent and 77.5 per cent respectively in 2008.
• Anti-cancer treatment is usually not possible without this type of diagnosis, but the latter can carry significant risks for some patients; usually because of other existing diseases or because they are very unwell. Therefore the optimum rate for histological or cytological diagnosis is likely to be between 75 and 80 per cent. The expertise of a trust's clinical team will, to an extent, be reflected in the rate recorded.
• There are no international data available with which to compare these findings.

CT scan before bronchoscopy

• 84.8 per cent of patients in England and Wales and 92.9 per cent of patients in Scotland received a CT scan before bronchoscopy, compared to 76.0 per cent of patients in England and Wales in 2008 and 86.4 per cent of patients in Scotland in 2009 (2008 data is not available for Scotland).
• A CT scan helps identify the best method for obtaining tissue and establishing the final diagnosis and stage of disease. It may show a tumour to be inaccessible via the large airways; which means that the patient may not be suitable for bronchoscopy; an uncomfortable and invasive test.
• There are no international data available with which to compare these findings.

Consultant in Respiratory Medicine Dr Mick Peake, audit clinical lead and clinical lead for NHS Cancer Improvement and the National Cancer Intelligence Network said: "The National Lung Cancer Audit has exceeded all our hopes and expectations both in terms of the quality and comprehensive nature of the data and the impact that it is clearly having on the care of lung cancer patients in the UK. It is our hope and expectation that we will be able to see these changes reflected in improved survival rates when we follow these patients up for a longer period."

The audit report can be accessed at www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/audit-reports/lung-cancer

Please also see the NCAPOP library >>

 

Notes 4-8 in this news release

4. 2008 is used as a baseline year because it was the first year in which every trust in England and Wales participated in the audit.

5. Imperatori A, Harrison RN, Leitch DN et al. Thorax, 2005;61:232-239.

6. Myrdal G, Lamberg K, Lambe M, Stahle E, Wagenius G, Holmberg L. Lung Cancer, 2009;63:16-22.

7. Fry WA, Philips JL, Menck HR. Cancer, 1999;86:1867-76.

8. Damhuiss RAM and Schutte PR. Eur Resp J, 1996;9:7-10.