14th January 2022

National Lung Cancer Audit 2020

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Report reveals grim toll of COVID-19 as lung cancer survival rates and diagnoses plummet

Charity calls for national screening programme to turn tide and save lives.

The impact of the pandemic on lung cancer is laid clear in the latest National Lung Cancer Audit (NCLA) published by the Royal College of Physicians (RCP) today (Friday 14 January).

This annual report provides information on the care and outcomes for patients diagnosed with lung cancer between 1 January 2019 and 31 December 2019 in Wales and Guernsey and between 1 January 2019 and 31 December 2020 in England.


In January 2019, the situation for lung cancer appeared promising. Both the one-year survival rate for lung cancer and the number of people being diagnosed at stages 1 and 2 were rising. 

Yet just 12 months later, that picture had changed significantly – and not for the better.

The report reveals that in 2020 there was a significant drop in the curative treatment rate (down from 81% to 73%), fewer lung cancer patients in England and Wales had surgery with curative intent (down by a quarter, from 20% to 15%), fewer patients were likely to receive an early diagnosis, and more cases were likely to be diagnosed via emergency presentation at hospital.

The pandemic also had a direct effect on the process of compiling the Audit. The report uses data provided by Public Health England (PHE), the Welsh Cancer Network and lung cancer teams in Guernsey to provide a summary of key findings, national averages and geographical variance across agreed lung cancer service performance indicators and patient outcomes.

The impact of COVID-19 meant that PHE staff at the National Cancer Registration and Analysis Service (NCRAS) were unable to provide the quality-assured data that have been a cornerstone of previous reports.

However, for the first time, the report uses data from the Rapid Cancer Registration Dataset (RCRD) for England which is more up to date than in previous years, and covers patients diagnosed over two years in England. Welsh audit data are not compared with those from England due to differences in processing data in the two nations.

Key findings

  • – In 2019, in England, the incidence of lung cancer recorded in the RCRD was 83% of the figure for 2018 – but that figure was compiled from the full registration dataset. The RCRD data for 2019 included far fewer patients with more advanced stage lung cancer than the 2018 data. As a result, the one-year survival figure of 46% for patients diagnosed in 2019 (compared with 39% in 2018) is not an accurate representation of all patients, and shows that the RCRD is skewed towards those patients with better survival.
  • – For patients diagnosed with lung cancer in 2019, one-year survival improved compared with 2018.
  • – In 2019 in England, curative treatment rates of NSCLC patients with stage 1 and 2 and good performance status from the RCRD were 81%. This figure fell significantly to 73% in 2020, with surgical resection rates down from 20% to 15%.
  • – Compared with 2019, lung cancer patients diagnosed in England had worse performance status, were more likely to be diagnosed via emergency presentation, and less likely to have a pathological diagnosis.
  • – In 2019 in Wales the rates for surgical resection (16%), chemotherapy in small-cell lung cancer (65%) and systematic anti-cancer treatment for stage 3B to Stage 4, PS 0-1 NSCLC patients (54%) remain below the audit standards and have remained static for the past few years.

Within the report, Dr Jesme Fox, medical director of Roy Castle Lung Cancer Foundation, writes:

‘’All of us involved in lung cancer care have been aware that COVID-19 has wrought havoc across the entire pathway. We saw the Targeted Lung Health Check programme paused between April and July 2020. People with potential symptoms of lung cancer have heeded stay at home messages and not presented to their GP. We have seen restricted access to diagnostic services and big reductions in clinic referral for investigation. There has been a necessity to alter treatment pathways, focusing on fewer hospital visits and infection control, dealing with the reality of health services focused on and consumed by COVID-19. We have been aware of this reality but now, with this NLCA report, we have the data to show the actual impact. It makes for challenging reading.’’

Paula Chadwick, chief executive of Roy Castle Lung Cancer Foundation, is calling for an urgent response to reverse the damage.

She said, ‘’Over the past two years, we have witnessed the impact COVID-19 has had upon lung cancer. While not unexpected, this report is distressing.   

‘’For a moment at the start of 2019 there was real cause for optimism for lung cancer, with improvements in survival rates, more people receiving curative-intent treatment, and – crucially – real advances in early diagnosis. Now the situation has changed, and lives are being lost. People are dying when they could be saved.

‘’Our task is clear: we must turn this ship around. Early diagnosis is the golden key to changing outcomes for patients. We are currently working with the NHS to promote the uptake of Targeted Lung Health Checks, which can – and do – save lives.

‘’The key recommendation within this Report is that the UK National Screening Committee should review the latest evidence as they consider a national programme for lung cancer screening. This is what we need to increase the number of patients diagnosed at an early stage, when treatment can be most effective. ‘’

’This report makes it crystal clear that the need for a screening programme has never been more urgent. If we are serious about bringing lung cancer out from the shadow of the pandemic, about saving more lives, then this must be the way forward.’’   

Targeted Lung Health Checks (TLHC)

These are a way to ensure that all is well and that your lungs are working as they should be.

We often refer to them as an ‘MoT for your lungs’. Just as we have our cars checked every year, it makes sense to look after our lungs. Most people who attend a targeted lung health check find it leaves then feeling reassured.

They are aimed at a specific group of people whose risk of lung cancer or other respiratory disease is higher than average.  They are currently available in selected areas of England for people aged 55-74 years old who have ever smoked.

Linda, who lives in Nottingham, owes her life to a lung health check.

She said, “I was invited to Roy Castle Lung Cancer Foundation’s lung health check back in 2017. I had no reservations about going. I always go to smear tests and mammograms. It’s so important.

At the appointment, I was diagnosed with chronic obstructive pulmonary disease (COPD) and referred for a CT scan at the mobile unit in the GP surgery car park.

The scan discovered two small nodules inside my right lung. I was referred to a specialist that same week. The good news was they believed the nodules weren’t cancerous. However, they recommended keeping an eye on them for any signs of growth.

I had follow-up scans every three months. At my third scan, nine months after my original lung health check appointment, the nodules had grown. They biopsied them and confirmed they were in fact cancerous.

I was shocked because even though the nodules had grown and were malignant, I still had absolutely no symptoms. There was no warning light to suggest anything was wrong so which this intervention, chances are I would have carried on completely unaware that I had cancer.

That is why these lung health checks are so important. My husband, David, died of lung cancer and it was so fast. He passed within six months of his diagnosis. However, thanks to the lung health check, my story is very different.

“I can’t express how grateful I am. If I hadn’t gone for that test, I don’t know how far the cancer would have spread before I would have found out. It saved my life.”

Linda was diagnosed through our lung health check in Nottingham. She is one of 11 people to be diagnosed as a result of the pilot, which saw a 64% of those diagnosed get caught early and offered curative-intent treatment. She is one of two people who were diagnosed at a follow up scan.

Now we are supporting the roll-out of further targeted lung health checks across England. At present, they are not available to people in Scotland, Wales or Northern Ireland, but we are working hard to change that.

Learn more about our role in targeted lung health checks.