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

This means the gap between the UK and other countries in Western Europe, who have historically been rated as having higher quality care, is narrowing; while in the UK itself the margin between the highest and lowest performing providers has also reduced in a positive direction.

Lung cancer kills more people in the UK each year compared to any other form of cancer. The audit contains data for almost 100 per cent of the estimated 38,057 UK cases first treated in 2010 that presented to secondary care; a participation level thought to unprecedented for any other audit in the world.

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.

The audit shows that for key treatment measures in 2010:

Surgery

• 13.7 per cent of patients in England and Wales and 11.7 per cent of patients in Scotland received an operation, compared to 10.8 per cent and 10.6 per cent respectively in 2008.
• Lung cancer is often diagnosed at an advanced stage, meaning up to three quarters of patients are not suitable for surgery. The 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.
• It is difficult to draw exact comparisons between the UK and other countries as most have differing forms of data. However, available information suggests UK surgery rates, although improving, are still lower than in other countries:

Italy – 25 per cent

Sweden – 17.5 per cent

USA – 27 per cent

Holland – 20 per cent

Anti-cancer treatment (surgery, chemotherapy and radiotherapy)

• 58.4 per cent of patients in England and Wales and 63.9 per cent of patients in Scotland received an anti-cancer treatment, compared to 54.0 per cent and 64.1 per cent respectively in 2008.
• Not all patients will be suitable for anti-cancer treatments, as for some the disease will be of a very advanced stage.
• Although international comparisons are limited; data for Sweden suggests about 66 per cent of patients receive anti-cancer treatment.

Histological/cytological diagnosis (tissue biopsy)

• 76 per cent of patients in England and Wales and 77.1 per cent of patients in Scotland received a histological or cytological diagnosis, compared to 72.2 per cent and 77.5 per cent respectively in 2008.
• Anti-cancer treatment is usually not possible without this type of diagnosis, but the latter 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 between 75 and 80 per cent. The expertise of a trust's clinical team will, to an extent, be reflected in the rate recorded.
• There are no international data available with which to compare these findings

CT scan before bronchoscopy

• 84.8 per cent of patients in England and Wales and 92.9 per cent of patients in Scotland received a CT scan before bronchoscopy, compared to 76.0 per cent of patients in England and Wales in 2008 and 86.4 per cent of patients in Scotland in 2009 (2008 data is not available for Scotland).
• A CT scan helps identify the best method for obtaining tissue and establishing the final diagnosis and stage of disease. It may show a tumour to be inaccessible via the large airways; which means that the patient may not be suitable for bronchoscopy; an uncomfortable and invasive test.
• There are no international data available with which to compare these findings.

Consultant in Respiratory Medicine Dr Mick Peake, audit clinical lead and clinical lead for NHS Cancer Improvement and the National Cancer Intelligence Network, said: “The National Lung Cancer 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.”

The audit report can be accessed at www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/audit-reports/lung-cancer

ENDS

Notes to editors

1. The NHS Information Centre (The NHS IC) is England's authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS IC also produces more than 120 statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics. The NHS IC is the largest single provider of clinical audits to the NHS and carries out a range of audits, mainly funded by the Healthcare Quality Improvement Partnership, into cancer, heart disease and diabetes.
2. The Royal College of Physicians (RCP) has been supporting and representing physicians for nearly 500 years. The College sets and monitors standards of medical training to ensure that patients are treated by fully trained and capable doctors, and provides education programmes, lectures, conferences and courses. It also takes a wide role in public health, campaigning for change, advising government and Parliament, and taking part in national debates on medical, clinical and public health issues. It runs a vibrant programme of projects that aim to improve the quality of health care in line with the best evidence for clinical practice: national comparative clinical audit, the measurement of clinical and patient outcomes, clinical change management and guideline development.
3. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.
4. 2008 is used as a baseline year because it was the first year in which every trust in England and Wales participated in the audit.
5. Italy figures: Imperatori A, Harrison RN, Leitch DN et al. Thorax, 2005;61:232-239.
6. Sweden figures: Myrdal G, Lamberg K, Lambe M, Stahle E, Wagenius G, Holmberg L. Lung Cancer, 2009;63:16-22.
7. USA figures: Fry WA, Philips JL, Menck HR. Cancer, 1999;86:1867-76.
8. Holland figures: Damhuiss RAM and Schutte PR. Eur Resp J, 1996;9:7-10.
9. For media enquiries and interview requests please contact the NHS Information Centre press office on 0845 2576990 or at mediaenquiries@ic.nhs.uk