Key lung cancer report from RCP shows encouraging rise in survival as more patients receive life prolonging treatments
Today’s report from The Royal College of Physicians shows a 7% increase in the number of people diagnosed with lung cancer surviving longer than one year since 2010.
In addition, 60% of lung cancer patients received anti-cancer treatments such as chemotherapy, radiotherapy, or surgery, meeting the target set out in the 2015 annual audit report.
Advances in Treatment for NSCLC
The report, commissioned by the Healthcare Quality Improvement Partnership (HQIP), highlights a significant rise in chemotherapy use for patients with advanced non-small-cell lung cancer (NSCLC). The proportion receiving chemotherapy increased by 16%, from 48% in 2008 to 64% in 2015. The percentage of NSCLC patients undergoing surgery has also risen to 16.8%.
To ensure all appropriate treatment options are considered, a diagnosis must be confirmed by a laboratory pathologist, a process called pathological confirmation. The report also recommends further sub-classification to collect more specific information about cancer type, stage, and the number of cells affected.
The number of cases with pathological confirmation increased to 72% from 69% in the previous year. Meanwhile, the number of cases where the subtype could not be determined fell to 11%, meeting the target of 15% and continuing a positive trend seen over the past few years.
One-Year Survival on the Rise
One-year survival increased from 31% to 38% between 2010 and 2015. This reinforces the findings of the clinical outcomes and mesothelioma reports, also published by the National Lung Cancer Audit at the end of 2016.
Changes in data collection in England, through the National Cancer Registration and Analysis Service (NCRAS), allowed the audit to include over 6,000 additional lung cancer cases. This provided the most comprehensive picture of lung cancer care in the UK to date.
Despite this good news, the NLCA continues to show regional variations in survival rates and the treatments patients receive. Work must continue to ensure all patients access the best possible care.
Recommendations for Improving Care
The report sets out recommendations for healthcare professionals, managers, chief executives, and commissioners. These focus on three main areas: data completeness, process of care, and treatment and outcomes. The goal is to support lung cancer services in improving care regionally and nationally.
Key recommendations include:
- Review pathological confirmations below 80% to ensure best practice.
- Ensure at least 90% of all patients are seen by a Lung Cancer Nurse Specialist (LCNS), and that 80% have an LCNS present at diagnosis. (The report shows only 57% of patients currently meet this standard.)
- Multidisciplinary teams (MDTs) with anticancer treatment rates below 60% should review case notes to identify why patients did not receive treatment.
- MDTs with one-year survival rates below 38% should review their diagnostic and treatment pathways to ensure prompt diagnosis and appropriate care.
Expert Comments
Ian Woolhouse, NLCA senior clinical lead said:
“It is very encouraging to note that overall many of our audit indicators have improved compared to the last report.
Highlights include the improvement in pathological sub-typing of lung cancer, the use of chemotherapy and surgery in non-small cell lung cancer, and probably most importantly the improvement in one-year survival.
However, there is still much work to do to ensure that all lung cancer patients receive a standard of care that is equal to the best in the country and we implore all lung cancer units to critically review their results and work with our quality improvement team to achieve this.”
Dr Jesme Fox, Medical Director of Roy Castle Lung Cancer Foundation, said:
“The NLCA is a great source of information on lung cancer. It is really important that we monitor services and lung cancer patient outcomes, in a timely manner. This audit allows us to do that.
We are pleased to see this encouraging increase in patient survival. However, there is much still to do, to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care.”