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30 April 2009: Quality of lung cancer treatment in the UK varies from hospital to hospital and lags behind that available in other Western European countries, says a report published today.

The NHS Information Centre and the Royal College of Physicians have released the third annual report of the National Lung Cancer Audit. While the report shows an overall improvement in the quality of care being given by hospitals in the UK, it shows that some hospitals are failing to offer acceptable standards of practice in key aspects of care, including diagnosis and treatment.

The National Lung Cancer Audit is commissioned and funded by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme. The report shows that the UK's top-performing trusts deliver treatment that compares to anything available internationally.

However, overall both care and outcomes are below those reported by other Western European countries. Variations in care mean, for example, that the proportion of patients receiving any form of active anti-cancer treatment vary from a third in the lowest performing hospitals to 75 per cent in the highest performing.

The report focuses on patients first seen in 2007 and highlights:

• The overall proportion of lung cancer patients receiving any active anti-cancer treatment remains low at 51 per cent, but is up from 43 per cent in 2005. (a 75% treatment rate is published from Italy [1])
• More cases are reviewed by a multi-disciplinary team - 87 per cent - compared to 78 per cent in 2005.
• Surgery is carried out on only ten per cent of patients - though this has increased from 9% in previous years. Resection rates quoted from other countries include: 25% from Varese, Italy [1]; 20% from Holland [2] and 17.5% from Sweden [3].
• Patients treated at the highest-performing trusts are more than four times more likely to be given surgery - the main curative treatment for the condition - than patients in the lowest performing hospitals.
• Histological confirmation of cancer diagnosis is made in 68 per cent of patients but varies from fewer than 20 per cent to more than 85 per cent. Based on the performance of trusts in previous years, a histological confirmation rate of at least 75 per cent is a reasonable benchmark for acceptable practice and the overall confirmation rate is lower than would be expected (82% is the rate in Varese, Italy [1]).
• The overall proportion of patients with small cell lung cancer - a less common form of lung cancer - receiving chemotherapy was low at 61.9 per cent. Many trusts were achieving rates of 80 per cent or more.

The audit captured data on more than 26,000 patients in the UK, representing more than 75 per cent of the expected incident cases for the audit period.

NHS IC chief executive Tim Straughan said: "While there have been overall improvements in care since the previous audit in 2006, there's still a wide variation between hospitals which cannot be explained on the basis of differing patient profiles alone.

"Trusts need to look carefully at the areas where their performance varies with national averages and expected levels of attainment and address the underlying causes.

"The audit sets out clearly the standards of care trusts should aim to achieve which include greater use of multi-disciplinary teams and histological confirmation of more diagnoses.

"To accompany the audit, we are also offering trusts a local action-planning toolkit to help them benchmark themselves against quality measures and drive up the standard of care they are giving their lung cancer patients."

Jonathan Potter, Clinical Director of Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians said "The national lung cancer is now producing data which clearly reflects the overall quality of clinical care for people with lung cancer as well as the variation around the country. Clinicians will value the opportunity provided by the data to work with hospital management and commissioners to drive up the quality of care.

Robin Burgess, Chief Executive of the Healthcare Quality Improvement Partnership (HQIP) said: "The National Lung Cancer Audit really highlights the need to address for Trusts to address the shortfalls in care received by cancer patients. As with many HQIP commissioned national clinical audits, there is evidence that implementation of the practice changes identified leads to better patient care.

For more information, or to view the full report, click here.

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