Neal Navani, clinical lead at the National Lung Cancer Audit (NLCA), explains why we are running our spotlight audit of patients who were diagnosed in 2015 with early-stage disease and good performance status but did not undergo surgery.
Multidisciplinary teams (MDTs) in the UK know that treating patients who have early-stage lung cancer is far more effective than treating patients who have advanced disease. Despite important progress in the treatment of patients with metastatic lung cancer, the 5-year survival for patients who present with stage IV disease remains under 10%. In fact , a recent study published in the Journal of Clinical Oncology suggested that survival of patients with advanced lung cancer had improved by only 6 weeks between 2000 and 2011.
In contrast, treatment of patients with early-stage lung cancer is extremely effective. Surgery for early-stage disease is often curative and is associated with 5-year survival for 82% of patients with stage IA disease. However, some patients with early-stage disease are unable to have surgery due to their comorbidities or their wishes. Stereotactic ablative radiotherapy (SABR) has emerged as an important technique for treating patients with early-stage lung cancer: in randomised trials, SABR has a 3-year lung cancer survival of 95%.
There is significant variation across the country that is not explained by casemix.
Therefore, we could significantly improve outcomes by ensuring that as many patients with early-stage disease as possible are treated. The NLCA has reported annually on the proportion of patients who undergo surgery and, in particular, the proportion with early-stage disease and good performance status who undergo surgery.
The results from this year’s NLCA annual report are important for two reasons:
- The proportion of patients with stage I and II disease with good performance status who undergo surgery is low (58%).
- There is significant variation across the country that is not explained by casemix.
This year, the NLCA team plans to launch a spotlight audit of patients who were diagnosed in 2015 with early-stage disease and good performance status who did not undergo surgery. The spotlight audit will aim to understand why there is variation in this important metric and also how we can improve treatment rates with radical intent.
Preparation for this in-depth spotlight audit is well underway with our colleagues at the National Cancer Registration and Analysis Service (NCRAS). On 4 May, I visited Public Health England’s offices in Cambridge and worked on developing a portal that all trusts can access to enter data. The data-capture portal will provide trust representatives with a list of patients who have early-stage disease but who did not undergo surgery and ask a series of questions to understand why surgery did not take place, with particular reference to the treatment that has been undertaken and the patient’s wishes and comorbidities.
A user guide will be provided, and it will take about 10 minutes per patient to complete the data entry. The portal will also allow the user to check the patient’s trust allocation and any radiotherapy treatment that they have undergone.
The spotlight audit will aim to understand why there is variation in this important metric and also how we can improve treatment rates with radical intent.
We will be asking every trust in the country who contributes to the NLCA to also contribute to the spotlight audit, as well as pilot the portal in four trusts. We then hope to share it nationally for data entry in June and July and demonstrate the portal at the upcoming NLCA workshops in London and Leeds.
Before data can be entered by a trust, a user will have to register for access to the portal using their NHS email address. It may take a few working days for registration to be confirmed, so I urge trust representatives to register as soon as possible after they receive the notification.
The spotlight audit represents a very important new work stream for the NLCA. It is a significant piece of work that may help to explain variations in outcomes not only between trusts but also between the UK and other nations that have similar spending on care for patients with lung cancer.
Neal Navani, NLCA clinical lead