National Lung Cancer Audit

The National Lung Cancer Audit (NLCA) 2018 report demonstrates the key findings from the 14th annual audit for lung cancer patients diagnosed in 2017 in England, Wales, Guernsey and, for the first time, Jersey.

The purpose of the audit is to review the quality of lung cancer care, to highlight areas for improvement and to reduce variation in practice.

Executive summary

The report covers patients with lung cancer first diagnosed in 2017, and includes 39,205 patients; 37,677 in England, 2,195 in Wales, 30 in Guernsey and 72 in Jersey. It found:

• For the first time, we report the proportion of patients with stage I/II disease and performance status (PS) 0–1 who have pathological confirmation of cancer – the result of 89% only just misses the audit standard of 90%.
• 30% of patients are missing out on access to all the benefits of specialist nursing support.
• Systemic anti-cancer treatment rates in patients with NSCLC and advanced/good PS increased from 62% to 65%; this is the first time that our audit standard of 65% has been met.
• Chemotherapy rates in SCLC increased from 68% to 71%, exceeding our audit standard of 70%.
• Surgery rates in NSCLC increased from 17.5% to 18.4%.
• The curative treatment rate in early stage/good PS patients is relatively high at 81%, but we believe there is scope for this to be increased.
• One-year survival rates (37%) are unchanged.

The publication of the 2018 NLCA annual report means that data on the care provided to patients diagnosed with lung cancer in 2017, and the outcomes for these patients are now available for local lung cancer teams to analyse, evaluate and use for quality improvement.

Dr Paul Beckett, NLCA senior clinical audit lead

The latest report includes a number of important positive results:

• We see continuing improvements in data completeness with 85% completeness for performance status (PS), 96% for stage and 64% for recording of lung function in patients potentially suitable for curative treatment, compared with 82%, 96% and 56% respectively in the previous reporting period.
• For the first time, we report the proportion of patients with stage I/II disease and PS 0–1 who have pathological confirmation of cancer – at 89% the result only just misses the audit standard of 90%.
• Systemic anti-cancer treatment rates in patients with non-small-cell lung cancer (NSCLC) and advanced/good PS increased from 62% to 65%; this is the first time that our audit standard of 65% has been met.
• Chemotherapy rates in small-cell lung cancer (SCLC) increased from 68% to 71%, exceeding our audit standard of 70%.
• Surgery rates in NSCLC increased from 17.5% to 18.4%.

However, it is deeply concerning that nearly a third of all patients are missing out of access to a lung cancer nurse specialist.

Lung cancer nurse specialists play a pivotal role in ensure the quality of care a patient receives. Studies have even shown that people with lung cancer live longer and cope better with treatment when cared for by specialist nurses. They also have a lower risk of being admitted to hospital unnecessarily.

Workforce in the NHS is a huge issue and needs immediate attention. The government must recognise this ticking time bomb and take urgent steps to address and resolve this crisis if it is to meet the aims and objectives set out in NHS England’s long-term plan and ensure everyone receives the highest quality of care they deserve.

Read our full response to the latest audit