Quality improvement visit: North West Coast

I recently attended a lung cancer network site specific group (NSSG) education event that was organised for the North West Coast NSSG by Dr Shahedal Bari in Preston. I was accompanied by Emily Griffiths, the NSSG’s data improvement (DI) lead from the National Cancer Registration and Analysis Service (NCRAS).

The event focused on improving lung cancer outcomes, and included talks on lung cancer screening, enhanced recovery after surgery and the introduction of stereotactic ablative radiotherapy (SABR) as well as the National Lung Cancer Audit (NLCA) 2016 audit report. The meeting was well attended, predominantly by teams from trusts that are based in north Mersey and Lancashire.

I began my talk with a short discussion about the headline national results from our 2016 report and the recent changes to lung cancer data collection, including the use of registry datasets other than the Cancer Outcomes and Services Dataset (COSD) (such as the Systematic Anti-Cancer Therapy dataset (SACT) and the Radio Therapy Data Set (RTDS)).

I was asked a number of questions at the end of my NLCA talk, including the following questions, which led to an interesting and wide-ranging discussion.

‘Additional’ lung cancer cases identified by the NCRAS in this year’s report

1. Were the ‘additional’ lung cancer cases, identified by death certificates in the registry, really lung cancer?
2. Had the ‘additional’ cases really passed through secondary trust teams?

Emily was able to clarify these points, which led a discussion about trusts reviewing their patient-level data. The discussion also highlighted the outcome of deep-dive audits at a number of trusts, in parallel with NCRAS’ DI reviews, which all showed that the vast majority of the ‘additional’ cases were valid. I was also asked about ‘trust first seen’ allocation, in particular for one of the tertiary surgical centres, Liverpool Heart and Chest Hospital.

Quality improvement

1. How can we find more early cancers?
2. How can we look in more detail at stage III lung cancer cases that are treated with curative intent?
3. How can we look at survival in stage IV patients who are treated with palliative systemic therapy?

I was able to confirm that it will be possible to look at these quality improvement points with the new data collection methods that are available to the NCRAS and the NLCA, in particular the SACT and RTDS datasets.

There was also some discussion about data completeness for 2016 COSD submissions in general, and how to improve documentation of lung cancer nurse specialist (CNS) involvement in particular. Many North West Coast trusts had excellent CNS data completeness for their 2016 COSD submissions.

In summary, this was an enjoyable and well-attended educational event. It was lovely to see the enthusiasm of lung cancer teams in the North West Coast trusts and their engagement with the NLCA and our data collection.

Susan Harden, NLCA clinical lead

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