Each year, the Royal College of Physicians produces a report with measurements or ‘metrics’ relating to the treatment and care of people with lung cancer. Roy Castle Lung Cancer Foundation is proud to be among the stakeholder partners involved in preparing this report, the National Lung Cancer Audit (NLCA),
The NLCA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and works with a number of specialists to collect hospital and healthcare information and report on how well people with lung cancer are being diagnosed and treated in hospitals across England, Wales, (and more recently) Jersey and Guernsey.
Neal Navani is a consultant respiratory physician at University College London Hospital. He is the Senior Clinical Lead of the UK National Lung Cancer Audit at the Royal College of Physicians and also the respiratory representative on the current NICE lung cancer guideline and quality standards.
As he points out, the Audit has played a major role in shaping lung cancer services in England, the UK and beyond, since it was launched in 2005. It has had a significant impact on the number of lung cancer resections (surgical procedures), and at least indirectly, has increased the number of chest surgeons now working in our hospitals. It has also championed the role of lung cancer nurse specialists (LCNS), and again, helped to increase the number of LCNS in the UK.
The 2020 Audit Report uses data gathered from patients diagnosed with lung cancer during 2018, and includes 39,000 patients in England and Wales. So, it represents a ‘snapshot’ of care and treatment for lung cancer as it was then, which is worth bearing in mind given how services have been affected by the Covid-19 pandemic throughout this year.
Dr Navani highlights three main ‘encouraging’ findings:
- An increase in diagnosis of patients at an early stage – up from 26% to 29%.
- A corresponding drop in patients diagnosed with late-stage lung cancer
- Patients with Stage 3 lung cancer had a ‘significantly improved’ survival rate compared with patients in 2015.
There are some very positive metrics measure within the Audit, and that is encouraging. However, it is also important to note that there is still considerable room for improvement.
However, he also stressed that some areas of concern remain. These include:
- The resection rate is now stable – ie neither decreasing nor increasing in any significant way – as is the rate of histological confirmations (positive tissue-sample tests). Both can be modified by quality improvement techniques.
- The involvement of LCNS in patient care is lower than recommended. The report recognises the role that LCNS play in supporting patients and in increasing treatment rates. This needs to be improved.
He also draws attention to two new aspects of the report:
- The Quality Improvement Toolkit, which enables each individual NHS Trust to examine their data critically and provides a framework for improving specific areas of their work.
- Quality Improvement Stories, which provide ‘case studies’ showing how individual Trusts took on the challenge of improving key areas. Dr Navani cites the example of Mid-Essex Hospital Trust, which is now assessed as being among the very best-performing in two key areas.
Dr Navani concludes his overview of the report by confirming that funding for the National Lung Cancer Audit has been extended by the Health Quality Improvement Partnership up until October 2021. Plans are already being drawn up for the next report.
Our Medical Director, Dr Jesme Fox, has indicated that the format of the report may be revised next year. Updating the charity’s staff on the impact of Covid-19 on lung cancer diagnosis and care, Dr Fox said that various stakeholders were already in discussion about next year’s report as data from 2019 could not accurately predict the experience of lung cancer patients and clinicians in 2020.
In late 2014 the contract for the NLCA was awarded to the RCP and is now delivered in partnership with a number of key stakeholders:
- The National Cancer Registration Service at NHS England collects and processes the NLCA data through the Cancer Outcomes and Services Dataset (COSD).
- The University of Nottingham is sub-contracted through the RCP to provide the analysis.
- The audit is also delivered in partnership with the Society for Cardiothoracic Surgery, the Roy Castle Lung Cancer Foundation representing lung cancer patients, the Welsh Lung Cancer Special Advisory Group, the National Lung Cancer Forum for Lung Cancer Nurses and the British Thoracic Oncology Group.
- Clinical leadership is provided by lung cancer experts recruited through the Clinical Effectiveness and Evaluation Unit at the RCP.