Improving survival: how the 'Lung cancer clinical outcomes publication' is driving success

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Doug West, thoracic surgeon and audit lead for the National Lung Cancer Audit (NLCA), looks at the Lung cancer clinical outcomes publication (LCCOP) and how it continues to drive improvements in outcomes for patients.

To succeed, a surgical audit project like the LCCOP must support clinicians and teams to improve the services they provide to patients. This remit goes beyond just identifying units whose outcomes fall outside an expected range. It includes identifying good practice, and reporting process of care information that might impact on outcomes.

This latest LCCOP report, covering the 2016 calendar year, includes two units who recorded no patient deaths within 30 days of surgery. These are impressive results since these are generally major operations in patients who often have other systemic diseases. They illustrate a continuing trend of improved survival that we have seen in lung cancer over several years. These achievements have been made in the context of a 10% increase in activity compared with 2015, suggesting that surgeons are becoming more proactive, not less, in offering lung cancer surgery. 

In an effort to spread good practice, we asked three clinicians who have led service improvements or achieved unusually good results in lung cancer clinical outcomes to reflect on their experiences, and we have included their responses in the report.

Outliers

Almost inevitably when compared with national results, there are units whose results lie outside our outlier definitions. An outlier notification from a national audit is a stressful experience for those involved. A formal process of reflection on these results in a hospital trust is required. This process should highlight areas where improved processes or more resources are needed, and as always the goal is to improve the service provided for future patients.

An internal review might consider whether local practices have been compliant with NICE clinical guidance, NHS England commissioning guidance and other examples of best practice such as British Thoracic Society (BTS) and Society for Cardiothoracic Surgery (SCTS) guidance. The recent Getting It Right First Time (GIRFT) report in cardiothoracic surgery offers useful advice as well as a detailed analysis of each unit’s practice.

This year we have updated our advice to outliers, and in response to feedback we have added a template response document, which units can use to structure their review. The SCTS executive committee can also provide additional impartial support to surgeons involved on request.

These achievements suggest that surgeons are becoming more proactive, not less, in offering lung cancer surgery. 

Doug West, NLCA thoracic surgery audit lead

Metrics

We want to provide more information beyond just survival rates, to include other metrics of quality and patient experience. This year we have revised our reporting of unit resection rates, pooling all local multidisciplinary team (MDT) data to give a single figure that represents a unit’s resection rate. We have added all cause readmissions within 90 days this year, and this first year of data suggests a burden of morbidity following discharge that is higher than had been expected.

Lastly, we have provided the data this year in a downloadable Excel spreadsheet, allowing interested parties to perform their own analyses easily.

We hope you find this year’s report useful, and always welcome feedback on how the LCCOP project could be improved for future years.

Doug West, NLCA thoracic surgery audit lead