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Standard of lung cancer care improved slightly over past year, report shows

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8289 (Published 05 December 2012) Cite this as: BMJ 2012;345:e8289
  1. Jacqui Wise
  1. 1 London

Standards of care of patients with lung cancer vary substantially across the United Kingdom, the National Lung Cancer Audit has shown.

The latest figures show that standards of care are largely similar to those seen last year, albeit with small rises in the proportion of patients having surgery and anticancer treatment.1 2 However, there remains marked variation across trusts, health boards, and networks that cannot solely be explained by differences in case mix.

The eighth national audit analysed data on 38 528 UK patients with lung cancer first seen in 2011. They represent about 93% of new cases of lung cancer. The audit was managed by the NHS Health and Social Care Information Centre in partnership with the Royal College of Physicians and was commissioned by the Healthcare Quality Improvement Partnership.

In England and Wales the proportion of patients being given anticancer drugs rose by one percentage point to 60.1% this year, and the overall surgical treatment rate also rose by one percentage point to 14.7%. There was a marginal increase to 76.9% in the proportion of patients receiving a histological or cytological diagnosis, and the proportion of cases discussed by a multidisciplinary team remained stable at 96%.

The audit did show greater input from lung cancer nurse specialists, with the overall figure rising from 64% last year to 80% this year. The proportion of patients who had a lung cancer nurse specialist present at the time they were given their diagnosis also rose from 38% to 55%, although this was still short of the recommended 80%.

In Scotland 59.7% of patients had anticancer treatment in 2011, down from 63.9% in 2010, while the proportion of patients overall who had surgery fell slightly from 11.1% to 10.7%. However, among patients with confirmed non-small cell lung cancer the proportion having surgery rose from 16.3% to 18.5%. The audit also covered Northern Ireland, but the figures were not available in time to be included in the report.

The report says that there was marked variation in audit measures across organisations. Low numbers of cases or poor quality data may account for some of the variation seen, and some trusts must try to improve their data collection, it says. However, the interquartile range across organisations in the proportion of patients who had surgical treatment was 11% to 16.5%. For histological or cytological confirmation the interquartile range was 72.1% to 83.5% and for anticancer treatment it was 55% to 65.7%.

The Improving Lung Cancer Outcomes Project, set up by the Royal College of Physicians, is hoping to identify reasons for the variation in clinical outcomes identified through the national audits.3 Over 230 healthcare professionals have taken part in the project, and the final evaluation of the project is expected shortly.

Mick Peake, the audit’s clinical lead, who is also 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.”

Notes

Cite this as: BMJ 2012;345:e8289

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