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NLCA annual report 2014

The NLCA annual report 2014 provides a summary of comparative audit data on the treatments and outcomes for lung cancer patients who were first seen in NHS secondary care in 2013.

Key recommendations

England and Wales

  1. All Hospitals, trusts and health boards should participate in this national audit, should submit data on all patients presenting to secondary care diagnosed with either lung cancer, and should complete all relevant data fields for each individual patient.
  2. All hospitals, trusts and health boards are encouraged to submit validated data for future rounds of organisational audit.
  3. Data completeness for key fields should exceed 85% and for MDT completeness should exceed 95%.
  4. To improve risk-adjustment models, we recommend that for those patients who do not receive the first choice treatment due to a co-morbidity, details of the co-morbidity should be provided in at least 85% of cases; and for patients with Stage I-II and PS 0-1, completeness for FEV1 and FEV1% should exceed 75%.
  5. Maintain the level of 95% of patients submitted to the audit being discussed at a multi-disciplinary team (MDT) meeting.
  6. Histological/cytological confirmation rates below 75% should be reviewed to determine whether best practice is being followed and whether patients have access to the whole range of biopsy techniques.
  7. Non-small cell lung cancer, not otherwise specified (NSCLC NOS) rates of more than 20% should be reviewed to ensure that best practice histological diagnostic techniques including immunohistochemistry are being followed, in order that patients receive appropriate chemotherapy regimens.
  8. At least 80% of patients are seen by a lung cancer nurse specialist (LCNS); at least 80% of patients should have a lung cancer nurse specialist present at the time of diagnosis (note that these data are not available for Wales).
  9. For patients undergoing bronchoscopy at least 95% should have a CT scan prior to the procedure.
  10. Surgical resection rates for NSCLC below the England and Wales average of 16% should be reviewed. Furthermore, for early stage (I and II) disease, rates below 52% should be reviewed to ensure that patients on the margins of operability/resectability are being offered access to specialist thoracic surgical expertise (including second opinions).
  11. Active anti-cancer treatment rates below the England and Wales average of 60% should be reviewed.
  12. Chemotherapy rates for small cell lung cancer below the England and Wales average of 70% should be reviewed.
  13. Chemotherapy rates for good Performance Status (0-1) Stage IIIB / IV NSCLC below the England and Wales average of 60% should be reviewed.

This year’s report has made changes to reflect the new commissioning structures in the NHS. In previous years we have reported the results of the NLCA at National, Cancer Network, and Hospital Trust level. With the abolition of the cancer networks and the introduction of Strategic Clinical Networks (SCN) in England, different organisations have established different arrangements, with some maintaining their old network structure, others moving to the new SCN boundaries, and some taking a mixed approach.

Since the audit is not resourced to produce multiple reports with different groupings for the middle tier to suit individual preferences, we have decided to report the middle tier according to the SCN boundaries. We understand that this may cause difficulties in comparison with previous year’s data in some cases.