With the National Lung Cancer Audit (NLCA) about to embark on the second national organisational audit Dr Bhavani Adizie asks 'what is this audit' and 'why is it so important'?
As a specialist respiratory registrar who cares for people who have lung cancer, I thought that the main determinant of patient outcomes related to the severity of the case and to patient factors. However, as I rotated around different hospitals, I noticed that there was a wide variation in patients’ access to diagnostics and treatment modalities, according to the organisation of services in each particular hospital. Seeing how this directly impacts on individual patients led me to the work of the NLCA.
The NLCA continuously strives to drive up standards in diagnosing and managing lung cancer. Inspired by this ethos, I applied for a clinical research post out of my training, to join the NLCA team. My first task has been to become involved with preparing for our second organisational audit. I therefore thought that I would take the opportunity in this blog to reflect on the results from the 2014 audit and to share our plans for the next survey.
The NLCA continuously strives to drive up standards in diagnosing and managing lung cancer.
Results from the first national lung cancer organisational audit (2014)
Back in 2014, the NLCA reported its findings from the first national lung cancer organisational audit. We had a great response to the survey, with a 73% completion rate. The results demonstrated that there was a significant variation in lung cancer care across the country in terms of access to novel diagnostics, treatment modalities and treatment specialists.
We made a number of recommendations to help to address the variation, including:
- A maximum of 30 patients should be discussed per multidisciplinary team (MDT) meeting.
- Diagnostic and non-cancer cases should be discussed at a separate MDT meeting.
- Lung cancer nurse specialists’ (CNS’s) workloads should not exceed 80 new cases per whole-time equivalent per year.
- All lung cancer MDTs should have access to all diagnostic tests and prompt thoracic radiology and pathology input.
- All treatment modalities, including video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic radiotherapy, should be available to all patients.
- All trusts should participate in the next round of the national lung cancer organisational audit.
The results demonstrated that there was a significant variation in lung cancer care across the country.
What are we doing now?
We are currently building and testing the 2017 survey so that it is ready for circulation throughout June. As well as comparing the results with those from the 2014 audit, we will also specifically be looking to answer the following questions.
- Does on-site availability of key diagnostic tests correlate with better patient experience, more rapid diagnoses and higher treatment rates?
- Does access to newer treatment modalities, eg VAT lobectomy and stereotactic ablative body radiation therapy (SABR), correlate with higher radical treatment rates?
- Do whole-time equivalent lung cancer specialist numbers correlate with treatment rates and patient experience?
- What are the other key organisational determinants of patient experience, eg availability of CNSs?
Why is the national lung cancer organisational audit important?
I am excited to work on this project because I believe that the outcomes of the audit can lead to a real change in the management of patients with lung cancer. By defining factors that affect patient outcomes, we can guide national policy and recommendations about the minimum requirements that make a safe and effective lung cancer service. Importantly, on a local level we can also empower trusts to begin discussions with commissioners and hospital managers about local resources and staffing.
Dr Bhavani Adizie
Organisations in England and Wales will be hearing more from us soon, but in the meantime if you have any questions please do get in touch: NLCA@rcplondon.ac.uk