Lung cancer treatment continues to improve across the NHS

Lung cancer surgery rates are improving across the NHS

The publication of the latest NHS lung cancer audit (pdf) provides some of the best data yet on how people with lung cancer are treated around the UK.

This audit is extremely important – it allows individual NHS trusts and cancer networks to compare their record on delivering treatment with that of others across the UK, and as we’ve said before, there’s growing evidence that sharing data improves the quality of care.

In fact, lung cancer is one of several types of cancer for which there is a formal national audit (the others being bowel, head and neck, breast, oesophagus and stomach).  The lung audit was also one of the first, aimed at helping doctors and managers improve cancer outcomes and services, and began data collection in earnest in 2004.

The latest audit has exceeded expectations, generating one of the most complete national datasets on lung cancer in the world.

It covers patients first seen at a hospital in 2009. All but one NHS trust participated, and data were collected on a total of 37,637 patients – around 95 per cent of expected cases.

Surgery rates have increased as more data are collected (click to enlarge)

Improving the picture

But why is this necessary? What’s the point in collecting all this information?

In the 1990s and 2000s, international studies (like EUROCARE), and other research and analysis, suggested that UK lung cancer patients were less likely to get ‘active treatment’ – aimed at curing them or extending life – than patients in some countries in Europe and North America, and that our survival rates were correspondingly poor.

And within the UK, there was evidence of wide variation in the delivery of care, including access to diagnostic tests and pathology, lung specialists and potentially curative surgery and chemotherapy.

The new audit shows that some of the key measures of quality care have improved:

• Over 95 per cent of cases are now discussed by multidisciplinary teams;
• On average 59 per cent of patients received active treatment in England and Wales, and the figures were higher in Scotland and Northern Ireland, at nearly 65 per cent;
• The rates of curative surgery have increased to an average of 18.3 per cent for confirmed non-small cell lung cancer in England and Wales (see graph);
• Chemotherapy rates for small cell lung cancer now exceed 65 per cent in England and Wales and 69 per cent in Scotland.

This is extremely encouraging and suggests once again that collecting and sharing data can provide information on how hospitals are performing around the UK, leading to national improvement in the way patients are treated.

Variations still exist

Ensuring that we are comparing ‘like for like’ in studies like these has always been tricky. It depends on the quality and completeness of the data, and the ability to take into account differences in things like age and smoking rates between patients attending any given centre for treatment.

Key things that determine which treatments are offered to different patients with the same type of lung cancer are, firstly, cancer stage (i.e. how early or advanced their cancer is), and secondly, whether a patient is well enough to have treatment – their so-called ‘performance status’.

It is encouraging to see that, in the latest audit, substantial progress is now being made in recording cancer stage and performance status – although the results haven’t yet been adjusted to take this into account.

The audit’s authors say that there are still significant variations in treatment rates around the country, in keeping with the findings from other recent studies.

The question is whether these variations are due to differences in patients between trusts (so-called ‘case mix’) or differences in the way different hospitals treat patients. The authors suspect that both are important:

Despite these improvements, there remains variation across trusts and networks and differences in case-mix do not appear to explain the whole of this variation.

They say fully-adjusted analysis of the data will appear on the NHS Information Centre website in due course, and will shed more light on this crucial question.

The future

The achievements of the lung cancer teams who contributed the data, and of the project team who co-ordinated the audit, must be applauded – but we should not be complacent.

The NHS now needs to accelerate progress in how data are collected for all types of cancer. In particular, we want to see improvements in data collection on individual patients, in real time, as an integral part of care – with automatic uploading of data, rapid merging of datasets and analysis linked to the ultimate treatment outcome – survival.

Only then, we will be able to claim that we have the best cancer intelligence in the world. Because through this, we can make things better for the people who really matter – people with cancer.

Lesley