Lung cancer

Earlier diagnosis and greater access to treatment will help to increase survival from lung cancer

This week the National Cancer Intelligence Network (NCIN) – the organisation responsible for collecting data about cancer and its treatment – revealed alarming figures showing that the lives of more than 5,400 lung cancer patients could have been lengthened if everywhere in England offered the best access to surgery for the disease.

This research is part of an ongoing project keeping tabs on the degree to which patients have access to cancer surgery across the UK – an essential first step in understanding why inequalities in access to treatment exist and how healthcare providers and policy-makers can change them.

In the UK, lung cancer survival rates continue to lag behind the best in Europe, and improving survival from the disease is a major strategic priority for both Cancer Research UK and the NCRI.

In a session at this year’s NCRI Cancer Conference optimistically titled “Lung cancer treatment: we have lift-off!” there was much to be excited about, but also many challenges that remain unresolved.

Here are some highlights from the session.

The lung cancer lottery

Drawing on the latest figures from the NCIN, Dr Mick Peake highlighted the worrying differences in the proportion of patients receiving lung cancer treatment (including radiotherapy, chemotherapy and surgery) across the country.

Although more analysis is needed, it’s highly likely that these differences are leading to a big disparity in survival between different NHS Trusts, which urgently needs addressing to bring everywhere up to the same standard.

Dr Peake’s number-crunching also revealed that the chances of a patient receiving surgery were strongly dependent on whether their treatment centre had ‘on tap’ surgeons specialising in lung cancer operations.

Likewise, people being treated at centres that put a lot of patients forward for clinical trials were more likely to receive chemotherapy, even without being involved in a trial themselves. And Dr Peake also showed an important role for Cancer Nurse Specialists in helping patients to make informed decisions about their treatment, increasing the number of people who opt for life-extending treatment options such as surgery.

It was also pleasing to see the impact of new technology on treatment. The rates of so-called “open/close” surgery (where surgeons open up a patient but discover their cancer is too advanced to attempt removal) dropped dramatically following the introduction of routine CT scanning and PET scanning, saving many lung cancer patients from unnecessary operations that are unlikely to benefit them.

But the biggest problem standing in the way of improving lung cancer survival in the UK continues to be the fact that the disease is often diagnosed late. As we’ve discussed before, diagnosing cancer earlier could save thousands of lives in the UK. Dr Peake showed that there continues to be a wide variation across the country in the rate at which GPs refer people with potential lung cancer for diagnostic X-rays, with startling differences even within a single area.

Understanding the root causes of all these differences in access to treatment and early diagnosis is crucial if there is to be a significant improvement in lung cancer survival in the UK.

Researching better treatment

As well as stressing that patients need better access to treatments, the next two talks in the lung cancer session highlighted the importance of research into improving the effectiveness of the treatments themselves.

Professor Suresh Senan, from the VU University Medical Centre in Amsterdam, talked about his experiences of giving a new type of radiotherapy – known as SABR or SBRT, or by the brand name Cyberknife – to lung cancer patients. In some cases, Professor Senan has found that SABR can be just as effective as surgery in prolonging survival, and has relatively few side effects.

As well as hearing about his research data, it was fascinating to hear about Professor Senan’s tussles with lung cancer surgeons, who often maintain that radiotherapy can’t help improve survival, despite his data showing that it can.

The session was wrapped up by Dr Luis Paz-Arez from Spain, who took the audience on a whistle-stop tour of the latest targeted treatments for lung cancer. He highlighted the importance of developing effective tests to figure out which patients might benefit from these expensive new drugs – which, in some cases, can have significant side effects – to make sure the right people get the right treatments.

This was yet another reiteration of the importance of stratified medicine – delivering treatment based on the genetic makeup of a patient’s tumour – which we’ve heard about many times at this year’s conference.

As the session wrapped up it was clear that we still have a long way to go before we’ve beaten lung cancer. But by ensuring that as many patients as possible across the UK get access to the best treatment and early diagnosis, healthcare providers and policy makers could make a significant impact in helping to beat this terrible disease.