The new report published by the Royal College of Physicians (RCP) and the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) demonstrates further improvements in survival rates following lung cancer surgery as the number of operations to treat the disease increases.
Rising from 95.5 to 96.2% over 2 years from 2012 to 2014, the consistent improvement in the number of people living longer than 90 days after surgery, together with an increase in number of operations to treat lung cancer, is encouraging.
The number of operations performed in the treatment of lung cancer increased 16% between 2013 and 2014, with a year-on-year rise in surgical interventions from 4,895 in 2013 to 5,657 in 2014.
In the past, diseases like heart disease or emphysema made it impossible for some patients to have surgery. Recent advances including minimal access surgery, regional anaesthesia and Enhanced Recovery After Surgery (ERAS) programmes have now made surgery an option for more patients, which may explain the increase in the number of operations performed.
Despite the rise in 90-day survival post-surgery, the 30-day survival rates remained broadly static, whilst still at a reassuringly high level of 97.9%.
The third Lung Cancer Clinical Outcome Publication (LCCOP) reports on the outcomes of operations to remove lung cancers in NHS hospitals in England during 2014, however this is the first time that the data gives consideration to the extraneous variables influencing the survival of individual patients. The treatment and prognosis for people diagnosed with lung cancer is often dependent on many factors, such as age and lifestyle. Having access to a broader range of more data enables the audit to create a far more detailed picture of the care that lung cancer patients receive across England.
Dr Ian Woolhouse, senior clinical lead on the National Lung Cancer Audit (NLCA), said:
This most recent LCCOP report shows an impressively high level of post-operative survival and it is reassuring to see that this kind of surgical treatment, although often complex, is now widely available to patients suffering with this common type of cancer.
The LCCOP is an invaluable report that demonstrates the individual activity of surgeons and their specific contribution to lung cancer care.
Doug West, thoracic audit lead for the SCTS, said:
We welcome this latest LCCOP report, which shows that the NHS is delivering more surgery for lung cancer, while survival after surgery shows some improvement. Survival is consistently good, with no units identified as outliers.
The new data reported this year, including length of stay and 1-year survival, should help patients and families make informed choices about their care.
The LCCOP audit measures outcomes of individual consultant thoracic and cardiothoracic surgeons who carry out surgery for lung cancer. The data is published as part of the NLCA programme, in response to an initiative of NHS England (Everyone Counts: Planning for Patients), aspiring to create greater transparency and, as a result, more choice for patients and commissioners.
The information published in this report is also available on NHS Choices, and enables patients to make informed decisions about the treatment that they receive and where they are able to receive it. This is an excellent example of placing individuals at the centre of their own care, helping to ensure that they receive the appropriate care from highly trained professionals.
Full data are available from the Society of Cardiothoracic Surgery in Great Britain and Ireland.
Patient case study: Adrian Morgan
Adrian, 58, has severe chronic obstructive pulmonary disease (COPD). He presented in 2015 with a large right middle lobe tumour and a single metastasis in the upper lobe. After a period of pre-operative pulmonary rehabilitation he underwent a video-assisted thoracic surgery (VATS) middle lobectomy and wedge of an upper lobe metastasis in July 2016. He has subsequently had four cycles of adjuvant chemotherapy. So far he remains well and is continuing to attend follow up clinics.
This is Adrian’s story:
I have had COPD since 2006. In autumn 2013 my breathing worsened. I saw a pulmonary consultant in August 2014. I was prescribed medical oxygen. Various tests followed. I was at 'end-stage' COPD. A bronchoscopy in January 2015 led to a collapsed lung, and a PET [positron emission tomography] scan indicated two tumours. In March, I was told my chances of dying during lobectomy lung surgery were six times higher than someone suffering lung cancer without COPD.
To give myself the best chance of a good recovery, before undergoing the operation I was advised to go on a short course of pulmonary rehabilitation exercises. These helped. I could see improvement, though my lung function was still bad. I went in for surgery on 7 July 2015. I made preparations for my cats to be cared for should things go wrong. The right middle lobe was removed, along with morbid tissue from the upper lobe. Two adenocarcinomas were taken out. After surgery I spent two nights in the intensive care unit with surgical emphysema then 2 weeks on a ward. A pump drained fluid from the lung but it took 2 weeks for it to fully inflate. I spent each day pacing the corridors with a digital pedometer, increasing the distance daily (with rests). On the final day, I managed 11 km (6 miles).
I had chemotherapy for 3 months, but now, almost 17 months after the operation, I feel optimistic. I still have COPD, but my breathing is better. I feel alive. Without surgery, I would probably not be here now.
Commenting on Adrian’s treatment, Doug West, thoracic audit lead for the SCTS, said:
Adrian's experience illustrates many of the reasons why surgical units across England have been able to perform more potentially curative surgery for lung cancer. Careful assessment and maximisation of fitness before surgery, together with modern, less invasive surgery and anaesthesia has made surgery an option for patients like Adrian. Just a few years ago it is unlikely that he would have been offered an operation.
Further information on the NLCA and LCCOP programme
The National Lung Cancer Audit (NLCA) is an established and valued national clinical audit whose work dates back to 2003. It currently forms part of the National Clinical Audit Programme. The NLCA programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)*, and is managed by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians. For more information please contact firstname.lastname@example.org.
The Society for Cardiothoracic Surgery in Great Britain and Ireland is the representative body for cardiothoracic surgery in Great Britain and Ireland and aims to continuously improve the quality of healthcare.
About HQIP, the National Clinical Audit Programme and how it is funded
The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands.
- National Cancer Registration and Analysis Service – run by Public Health England and is responsible for cancer registration that has been an integral part of the NHS for over 50 years.
- Roy Castle Lung Cancer Foundation – a registered charity, whose mission is to beat lung cancer by funding innovative world-class research and aims through early detection and patient experience to make a significant impact on lung cancer for the benefit of patients.
- British Thoracic Oncology Group – a UK lung cancer and mesothelioma research group that aims to improve the care of patients with thoracic malignancies through multidisciplinary education and clinical and scientific research.
- Nottingham University – a research group that offer methodological and analytical support of the NLCA.
- National Lung Cancer Forum for Nurses – established in 1999 to provide networking and support to nurses specialising in the care of people with lung cancer.
- National Specialist Advisory Group for lung cancer Wales – provides all Wales clinical specialist advice on cancer in Wales.