National Lung Cancer Audit Research Articles

Lung cancer survival in England: trends in non-small-cell lung cancer survival over the duration of the National Lung Cancer Audit

Background:In comparison with other European and North American countries, England has poor survival figures for lung cancer. Our aim was to evaluate the changes in survival since the introduction of the National Lung Cancer Audit (NLCA).Methods:We used data from the NLCA to identify people with non-small-cell lung cancer (NSCLC) and stratified people according to their performance status (PS) and clinical stage. Using Cox regression, we calculated hazard ratios (HRs) for death according to the year of diagnosis from 2004/2005 to 2010; adjusted for patient features including age, sex and co-morbidity. We also assessed whether any changes in survival were explained by the changes in surgical resection rates or histological subtype.Results:In this cohort of 120 745 patients, the overall median survival did not change; but there was a 1% annual improvement in survival over the study period (adjusted HR 0.99, 95% confidence interval (CI) 0.98–0.99). Survival improvement was only seen in patients with good PS and early stage (adjusted HR 0.97, 95% CI 0.95–0.99) and this was partly accounted for by changes in resection rates.Conclusion:Survival has only improved for a limited group of people with NSCLC and increasing surgical resection rates appeared to explain some of this improvement.

Increasing the Surgical Resection rate for Lung Cancer in the UK: The Debate

SUMMARY The UK has historically had poorer survival statistics for lung cancer and, indeed, most other cancers than major comparator countries. While there have been modest improvements in survival for lung cancer patients internationally in recent years, the gap between the UK and a number of other western countries has not narrowed. In parallel with this, the surgical resection rate for lung cancer patients in the UK has historically been very much lower than those reported from many other countries. Since surgery is the treatment that is most likely to result in long-term survival, it seems likely that the two findings are related. It is also clear that resection rates vary widely across the UK, that there is a positive correlation between resection rate and survival and that when specialist thoracic surgeons are employed in lung cancer multidisciplinary teams, resection rates rise quickly and dramatically. Effective auditing of the standards of care through the National Lung Cancer Audit project has identified problems at a national and local level and, with support from professional bodies, the UK has nearly doubled the number of specialist thoracic surgeons since 2005. A dramatic increase in resection rates followed, from approximately 3000 per annum in 2005 to 5000 per annum in 2010. There are parallels with a wide range of nonsurgical interventions in lung and other cancers, pointing to the fact that efforts need to be made to ensure that all patients have access to the optimum care from an expert multidisciplinary clinical team at all stages of their care.

Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit

IntroductionFor appropriately staged non-small cell lung cancer (NSCLC) surgical resection can dramatically improve survival, but some may not be offered this treatment because of concerns about perioperative mortality.MethodsWe used data...

205 90-day mortality after surgery for lung cancer – An analysis of the National Lung Cancer Audit

205 90-day mortality after surgery for lung cancer – An analysis of the National Lung Cancer Audit

The Effects of Increased Provision of Thoracic Surgical Specialists on the Variation in Lung Cancer Resection Rate in England

There is a wide variation in the lung cancer resection rate in England. We assessed the effect of the regional provision of thoracic surgery service on the variation in lung cancer resection rate. A retrospective observational study correlating National Lung Cancer Audit data with thoracic surgery workforce data was performed to review the lung cancer resection rate in England in 2008 and 2009. In 2008, there was a sixfold variation in resection rate, with a higher resection rate in hospitals where surgeons were based (base hospitals) than in peripheral hospitals (20.0% versus 11.6%, p < 0.001). The resection rate was also higher in cancer networks, which were served by two or more specialist thoracic surgeons (14.6% versus 12.7%, p = 0.028), and where surgeons were present in more than two-thirds of the lung cancer multidisciplinary team meetings (14.4% versus 12.0%, p = 0.046). In 2009, the overall resection rate increased from 14.5% to 18.4%. Four units increased their number of specialist thoracic surgeons and had a significantly higher increase in resection rate than units without expansion (relative rise 66.3% versus 19.2%; p = 0.022). The large variation in the resection rate seems, in part, to be related to the local availability of specialist thoracic surgeons. The greatest improvement in the resection rate was in units with expansion of specialist thoracic surgeons. We suggest the expansion of specialist thoracic surgeons will improve the resection rate and thereby the overall survival of lung cancer in England. This has significant implications for the future of training in cardiothoracic surgery and organization of cancer services.

The pathological confirmation rate of lung cancer in England using the NLCA database

BackgroundThe National Lung Cancer Audit (NLCA) recommends that trusts obtain pathology (histology or cytology) for 75% of their lung cancer patients, however this figure was arbitrarily chosen and the optimal pathological confirmation rate is unknown, and many countries report somewhat higher rates. The aims of this study were to provide a simple means of benchmarking appropriate pathological confirmation rates by stratifying patients into groups, and whether obtaining pathology based on those groups is associated with a survival benefit. MethodsWe calculated the proportion of patients with non-small cell or small cell lung cancer in the NLCA database, first seen between 1st January 2004 and 31st December 2010, who had pathological confirmation of their diagnosis. Using logistic we assessed the independent influence of patient factors on the likelihood of having histology or cytology, and the overall effect on survival. We also used bivariate analysis to identify the features which were most strongly associated with having pathology and performed Cox regression to identify any survival advantage. FindingsWe analysed data on 136,993 individuals. Age and performance status (PS) were the strongest predictors of pathological confirmation: age≥85 odds ratio (OR) 0.20 (95% confidence interval (CI) 0.19–0.22) compared with age<55; PS 4 OR 0.11 (95%CI 0.10–0.12) compared with PS 0. Pathological confirmation of diagnosis was associated with a small early survival advantage for groups 1 & 2 which represented younger patients with good PS, even after adjusting for other patient features: hazard ratio (HR) 0.93 & 0.89 respectively. ConclusionStratifying patients by age and performance status is useful and appropriate when benchmarking standards for pathological confirmation of the diagnosis of lung cancer. We have shown better survival at six months and one year for younger patients with better PS, even after adjusting for confounders. Much of the survival advantage was accounted for by adjusting for the use of chemotherapy.

P202 Risk Factors For Early Mortality After Lung Cancer Resection: A Study of the UK National Lung Cancer Audit

IntroductionSurgical resection is the best chance of cure for most patients with non-small cell lung cancer (NSCLC), for whom 5-year survival is otherwise poor. Selection of patients for surgery should...

P167 Pathological Confirmation Rate of Lung Cancer in England Using the NLCA Database

IntroductionThe majority of people with lung cancer should have pathological confirmation of their diagnosis. The National Lung Cancer Audit (NLCA) recommends that NHS trusts obtain pathology (histology or cytology) for...

S90 The National Lung Cancer Audit – No Evidence of a “Seven-Year Itch”

IntroductionThe National Lung Cancer Audit, now in its7th year, is run jointly by the Royal College of Physicians and The Information Centre for health and social care, and is commissioned...

P171 A Retrospective Study of Changing Performance Status and Staging in All Patients Presenting with Lung Cancer to the Northern Health and Social Care Trust Over the Past Decade

Lung cancer resection rates have become more controversial as the publication of the national lung cancer audit has shown such geographical variation and then national improvement over a small number...

P203 Addressing low surgical resection rates for Non Small Cell Lung Cancer: local intervention to address high levels of emergency presentations at late stage should be effective.

IntroductionThe National Lung Cancer Audit is a benchmarking tool for cancer networks and individual MDT’s. The national average resection rate for all lung cancer patients is 13.7%. The NLCA recommend...

P164 Lung Cancer Survival in England: Which Patients Have Demonstrated Improved Survival?

IntroductionSeveral recent studies have reported the overall survival of patients with lung cancer in England is improving. However, when compared with other European and North American countries, England still has...

P65 Increase in Lung Cancer Surgical Resection Rates Following a Regional Media Based Public Awareness Campaign

IntroductionLung cancer prognosis depends on staging at time of diagnosis and delayed presentation contributes significantly to poor survival rates. The Doncaster public awareness cough campaign resulted in a significant increase...

S92 Risk Factors and Outcome For Emergency Presentation in Lung Cancer Patients

IntroductionThe National Cancer Intelligence Network recently published an analysis of 226,000 cases of cancer and showed that 23% of all cancers had an emergency presentation as their “route to diagnosis”....

P168 Factors Associated with Advanced Stage Lung Cancer at Diagnosis – a Retrospective Cohort Study

IntroductionLung cancer is a major cause of mortality in the UK, with survival related to stage of disease at presentation. Better understanding of factors contributing to presentation delay might aid...

Clinical management of older people with non-small cell lung cancer in England

Data for 25261 patients with non-small cell lung cancer whose details were submitted to the National Lung Cancer Audit in England were analysed to assess the effect of age at...

Exploring variations in lung cancer care across the UK–the ‘story so far' for the National Lung Cancer Audit

The National Lung Cancer Audit was developed to improve the quality and outcomes of services for patients with lung cancer, knowing that outcomes vary widely across the UK and are poor compared to other western countries. After five years the audit is capturing approximately 100% of the expected number of incident cases across hospitals in England, Wales, Scotland, Northern Ireland and Jersey. Measures of process and outcome have improved over the audit period, such as the histological confirmation rate (64-76%), the proportion of patients discussed in a multidisciplinary team meeting (78-94%), and the proportion of patients having anti-cancer treatment (43-59%), surgical resection (9-14%) and small cell lung cancer chemotherapy (58-66%). These national averages hide wide variations between hospitals providing lung cancer care which cannot be accounted for by differences in casemix. This paper describes the evolution of the audit, and describes the ways in which it may have improved clinical practice.

178 The National Lung Cancer Audit (NLCA) does not accurately record chemotherapy administration for patients with small cell lung cancer (SCLC) in the Greater Manchester and Cheshire Cancer Network (GMCCN)

178 The National Lung Cancer Audit (NLCA) does not accurately record chemotherapy administration for patients with small cell lung cancer (SCLC) in the Greater Manchester and Cheshire Cancer Network (GMCCN)

120 Carcinoid tumour characteristics, treatment and outcome: results from the National Lung Cancer Audit 2005–2010

120 Carcinoid tumour characteristics, treatment and outcome: results from the National Lung Cancer Audit 2005–2010

71 Cross-system consistency of the National Lung Cancer Audit and SCTS Thoracic Surgery Database in a single cancer network

71 Cross-system consistency of the National Lung Cancer Audit and SCTS Thoracic Surgery Database in a single cancer network