Dr Paul Beckett, NLCA senior clinical audit lead, highlights some key messages from the 2018 annual report.
The publication of the 2018 NLCA annual report means that data on the care provided to patients diagnosed with lung cancer in 2017, and the outcomes for these patients are now available for local lung cancer teams to analyse, evaluate and use for quality improvement. Summarising the results from raw data on individual patients across more than 170 individual organisations is a monumental task, and I am very proud of the project team and all our partners who have worked so hard on it.
We have once again provided a bespoke dashboard for each individual organisation, highlighting their results against the national average, as well as showing the trends in performance over the past 5 years.
The report includes a number of important positive results:
- We see continuing improvements in data completeness with 85% completeness for performance status (PS), 96% for stage and 64% for recording of lung function in patients potentially suitable for curative treatment, compared with 82%, 96% and 56% respectively in the previous reporting period.
- For the first time, we report the proportion of patients with stage I/II disease and PS 0–1 who have pathological confirmation of cancer – at 89% the result only just misses the audit standard of 90%.
- Systemic anti-cancer treatment rates in patients with non-small-cell lung cancer (NSCLC) and advanced/good PS increased from 62% to 65%; this is the first time that our audit standard of 65% has been met.
- Chemotherapy rates in small-cell lung cancer (SCLC) increased from 68% to 71%, exceeding our audit standard of 70%.
- Surgery rates in NSCLC increased from 17.5% to 18.4%.
While these results continue the trend of slow and steady improvements that the audit has charted over the past 15 years, there is still unexplained and unwarranted variation across different organisations. Our outlier policy, introduced in 2017, is a key driver to encourage those organisations with the most divergent results to look closely at them and formulate action plans to recover performance. We have been encouraged by how enthusiastically the local lung cancer teams have embraced this process. There are also areas of care where improvements need to be made across the board, for example in the 30% of patients who are missing out on access to all the benefits of specialist nursing support.
Looking ahead, we are about to embark on a process that we hope will see the NLCA recommissioned for a further 3 years from 2020.
It may seem strange to be writing a blog in May 2019 about the publication of the 2018 annual report. I have written previously about the reasons for the long report timelines, and this took even longer this year due to the need for additional time for quality assurance of the data, and for the standardised reporting procedure (SRP) imposed on all national audits. We were disappointed not to be able to publish in conjunction with the British Thoracic Oncology Group (BTOG) 2019 conference, but we know that our audience values accuracy of data over timeliness, and confidence in the results of the audit are critical. Despite this, we will continue to look at options to reduce the time to publication across all of our work streams.
We have once again provided a bespoke dashboard for each individual organisation, highlighting their results against the national average, as well as showing the trends in performance over the past 5 years. For the first time this year, we have also analysed data at clinical commissioning group (CCG) level, and provided local dashboards highlighting three key measures (proportion of patients with early stage cancer, proportion of patients diagnosed though an emergency pathway, median survival), which we hope will begin to open up more conversations with commissioners.
Looking ahead, we are about to embark on a process that we hope will see the NLCA recommissioned for a further 3 years from 2020. An engagement event is planned with our users’ group to better understand which aspects of the audit work well and which fall short of expectation. We are also keen to hear from anyone with constructive feedback that will inform the direction of the audit in the years to come. Please email us at email@example.com.
Dr Paul Beckett, NLCA senior clinical lead