UK Audit Finds That Lung Cancer Care is Improving Every Year

The National Lung Cancer Audit announced that the proportion of patients receiving key care measures, such as surgery or anti-cancer treatment like chemotherapy or radiotherapy, is improving each year.

58.4% of patients with lung cancer in England and Wales and 63.9% in Scotland received an anti-cancer treatment in 2010, compared to 54% and 64.1% respectively in 2008, according to new government figures.

As a result, the gap between the UK and other western European countries, which have previously been rated as having higher-quality care, is narrowing.  In the UK, the gap between the highest and lowest performing providers has also reduced positively, the Audit notes.

The audit is managed by The NHS Information Centre in partnership with the Royal College of Physicians and commissioned by the Healthcare Quality Improvement Partnership.

Lung cancer kills more people in the UK every year than any other type of cancer.  The Audit contains data for nearly 100% of the estimated 38,057 UK cases initially treated in 2010 that presented to secondary care, a participation level which, it says, is “thought to be unprecedented for any other audit in the world.”

The Audit points out that not all patients will be suitable for treatment, such as surgery, chemotherapy and radiotherapy, as for some the disease will be at a very advanced stage.  It also notes that, while international comparisons are limited, information for Sweden suggests that about 66% of lung cancer patients there received an anti-cancer treatment.

The Audit also found that 13.7% of patients in England and Wales and 11.7% in Scotland received surgery for lung cancer last year, compared to 10.8% and 10.6% respectively in 2008.

Lung cancer is often diagnosed at an advanced stage, meaning that up to 75% of patients are not suitable for surgery.  The reported improved surgery rate suggests improving expertise among clinical teams to assess patients of borderline fitness for surgery and better access to more complex surgical techniques often needed in such situations, the Audit adds.

It is difficult to draw exact comparisons between different countries, but available information suggests that while UK surgery rates are improving, they are still lower than other developed countries.  For example, 25% of lung cancer patients in Italy receive an operation, while 17.5% in Sweden do so, 27% in the US, and 20% in the Netherlands.

Turning to tissue biopsy, the Audit found that 76% of patients in England and Wales and 77.1% in Scotland received a histological or cytological diagnosis last year, compared to 72.2% and 77.5%, respectively, in 2008.

While anti-cancer treatment is usually not possible without this type of diagnosis it can carry significant risks for some patients, usually because of other existing diseases or because they are very unwell; therefore, the optimum rate for histological or cytological diagnosis is likely to be 75%-80%, says the Audit.  The expertise of a trust’s clinical team will, to an extent, be reflected in the rate recorded, it adds.

Dr Mick Peake, the Audit’s clinical lead, consultant in respiratory medicine and clinical lead for NHS Cancer Improvement and the National Cancer Intelligence Network, commented that the Audit “has exceeded all our hopes and expectations, both in terms of the quality and comprehensive nature of the data and the impact that it is clearly having on the care of lung cancer patients in the UK.”

“It is our hope and expectation that we will be able to see these changes reflected in improved survival rates when we follow these patients up for a longer period,” Dr Peake added.


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