This report summarises the key findings from the 11th annual National Lung Cancer Audit (NLCA) for patients diagnosed with lung cancer in England, Wales, Guernsey and Scotland in 2014. The purpose of the audit is to review the quality of lung cancer care, to highlight areas for improvement and to reduce variation in practice.
We make a number of specific recommendations against which we will audit, analyse and report in the next annual report. Our recommendations require change, as is true for all quality improvement (QI). In future, the NLCA plans to support organisations to develop, implement and evaluate lung cancer QI strategies using NLCA data.
- Organisations should work to maintain or improve the quality of data submitted to the NLCA, including detailed clinical data to allow the most accurate risk adjustment to be carried out.
- Both performance status (PS) and stage should be recorded in at least 90% of cases.
- The ‘reason for no anticancer treatment’ field of COSD should be completed in 100% of relevant patients.
- For patients with stage I–II and PS 0–1, completeness for FEV1 and FEV1% should exceed 75%.
- All MDTs should appoint a ‘clinical data lead’ with protected time to allow promotion of data quality, governance and QI (to be measured through future rounds of organisational audit).
Process of care
- Pathological confirmation rates below 75% should be reviewed to determine whether best practice is being followed and whether patients have effective access to the whole range of biopsy techniques.
- Non-small-cell lung cancer, not otherwise specified (NSCLC NOS) rates of more than 15% should be reviewed to ensure that best practice histological diagnostic techniques including immunohistochemistry are being followed, in order that patients receive appropriate chemotherapy regimens.
- At least 90% of patients are seen by an LCNS; at least 80% of patients should have an LCNS present at the time of diagnosis.
- For patients undergoing bronchoscopy, at least 95% should have a CT (computerised tomography) scan prior to the procedure.
Treatment and outcome
- MDTs with lower than expected surgical resection rates for NSCLC (below 16% or low odds ratio after casemix adjustment) should perform detailed case-note review to determine why each resectable patient did not receive an operation, including whether a section opinion was offered to borderline fit patients.
- MDTs with lower than expected active anticancer treatment rates (below 60% or low odds ratio after casemix adjustment) should perform detailed case-note review to determine why patients with good PS did not receive active anticancer treatment.
- MDTs with lower than expected chemotherapy rates for SCLC (below 70% or low odds ratio after casemix adjustment) should perform detailed case-note review to determine why each SCLC patient did not receive chemotherapy.
- MDTs with lower than expected chemotherapy rates for good PS (0–1) stage IIIB/IV NSCLC (below 60% or low odds ratio after casemix adjustment) should perform detailed case-note review to determine why each advanced NSCLC patient with good PS did not receive chemotherapy.
In late 2014, the contract for the NLCA was awarded to the Royal College of Physicians (RCP) and is now delivered in partnership with a number of key stakeholders. The National Cancer Registration Service (NCRS) at NHS England collects and processes the NLCA data through the Cancer Outcomes and Services Dataset (COSD). The University of Nottingham, subcontracted through the RCP, provides the analysis. Clinical leadership is provided by lung cancer experts recruited through the Clinical Effectiveness and Evaluation Unit at the RCP.