23rd January 2018

The Need for Speed: How the NOLCP can be achieved

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In August 2017, NHS England signed off the Lung Cancer Clinical Expert Group’s (CEG) National Optimal Lung Cancer Pathway (NOLCP).

The National Optimal Lung Cancer Pathway aims to speed up diagnosis and treatment times

The pathway aims to cut lung cancer treatment times from the national standard of 62 days to 49 days. Key features include:

Chest x-ray (CXR) reporting within 24 hours CT within 72 hours of referral Clinic within 5 days of referral Pathology turnaround – 3 days to subtype, 10 days to full analysis Treatment – 5 days to clinic, 14 days to treatment from multidisciplinary team (MDT) decision to treat.

In short, the NOLCP is designed to get lung cancer patients diagnosed faster as well as improve waiting times for treatment.

It is an ambitious aspiration but one Professor David Baldwin, Chair of the CEG for Lung Cancer, is optimistic can be achieved.

He highlights how at this year’s British Thoracic Oncology Group’s (BTOG) conference:

“So is the National Optimum Lung Cancer Pathway achievable? It is important to understand that, whilst ambitious, the pathway was not simply plucked out of thin air. It has been developed following wide consultation with stakeholders and was designed by clinicians. What is more, we are already seeing it in action in a number of CCGs.

There is no doubt the times are challenging but the benefits will be unprecedented.

Prof. David Baldwin, Chair of the Lung Cancer CEG

“For example, in a Liverpool Hospital that was used to design the pathway, chest x-ray to CT scan is achieved within three days, whilst Crawley CCG, Horsham and Mid Sussex CCG and University Hospitals of North Midlands have seen a marked improvement in time to outpatient appointments and multidisciplinary team discussions.

“The Manchester Rapid Programme is a beacon of success and it is achieving many elements of the pathway:

Dedicated CT slots 8-9am Monday – Friday Specialist nurse review on arrival Radiology hot reporting 9-10am Daily physician triage and telephone outcome Daily bronchoscopy / endobronchial ultrasound (EBUS) list Daily percutaneous image-guide biopsy 2 x clinics a week Dedicated pulmonary function test (PFT) / shuttle / echo appointments 2 x MDTs a week Direct booking to surgical clinic.

“We do not expect trusts to work out how best to achieve this alone. The implementation guide provides links to case studies like the aforementioned that have implemented aspects of the NOLCP. These examples are provided to inspire others to make changes, on the basis that those arrangements have been successfully implemented in other localities.

“There is no doubt the times are challenging but the benefits will be unprecedented. We expect huge reduction in delay to diagnosis and treatment and improved survival as well as improving efficiency in our stretched NHS. It is achievable as long as we have the commitment from clinical teams and a nationally agreed approach.”

The late diagnosis of lung cancer is responsible for a significant proportion of lung cancer deaths. Around 35% of patients are diagnosed through Accident and Emergency (A&E) and, of these, only 13% survive for a year or more. The NOLCP aims to reduce emergency admissions and improve patients’ survival.

Paula Chadwick, CEO at Roy Castle Lung Cancer Foundation, adds:

“As the secretariat for the Lung Cancer CEG, we welcome the implementation of the pathway. The needs of lung cancer patients have been side-lined for too long. Over 46,000 people are diagnosed with lung cancer, with nearly 36,000 dying from the disease every year. Only 37% of lung cancer patients survive for a year or more, compared to 96% for breast cancer, 94% for prostate cancer and 76% for bowel cancer. And the 10-year survival rates are even more heart-breaking.

“We should all expect better – better research, better treatment and better outcomes – and we hope the pathway is the first step in ensuring lung cancer patients are diagnosed more quickly and thus dramatically improving their chance of beating this awful disease.”