The proportion of lung cancer patients getting active treatment varies widely from place to place, says an audit of NHS care published today.

The National Lung Cancer Audit Report 2009, shows the likelihood of getting active treatment (surgery, chemotherapy or radiotherapy) for lung cancer can be more than eight times higher in some places than in others, while the likelihood of having surgery can be more than six times higher.

Overall, the proportion of patients getting active treatment lags substantially behind that of other comparable countries.

The report covers lung cancer care in England, Wales and Scotland and covers patients who were first seen in 2008.

The data submitted to the audit shows:

• While 54 per cent of patients received active treatment for their lung cancer in 2008, up from 51 per cent in 2007, the proportion of patients receiving active treatment ranged from around 10 per cent in some areas to more than 80 per cent in others.
• The proportion of patients having surgery in an attempt to cure their cancer increased from ten per cent in 2007 to 11 per cent in 2008. However, the proportion of patients having surgery ranged from less than five per cent in some places to more than 25 per cent in others. The proportion receiving surgery in other comparable countries ranges from 15 to 25 per cent.
• Chemotherapy rates also vary widely across the country. The proportion of patients with the less common small cell lung cancer who received chemotherapy was 62 per cent - unchanged from last year and low compared to other countries - even though the condition responds well to this treatment.
• Only 51 per cent of patients were seen by a lung cancer specialist nurse and only a quarter had the specialist nurse present at the time of their diagnosis – even though they provide a vital supporting role for patients with lung cancer and mesothelioma. It is the first time figures for access to have a lung cancer specialist nurse have been recorded.

The NHS Information Centre's chief executive Tim Straughan said: “The quality of data submitted to the audit has improved on previous years enabling the report to paint a richer picture of the quality of care being delivered and to provide more detailed comparisons of cancer networks and trusts.

“Overall, it is clear that quality of care is improving slowly, however there remain wide variations in care which differences in casemix do not explain.

“Trusts should examine this report closely to see if their approach to lung cancer treatment varies from the recommendations or national averages and, if it does, to ask themselves the reasons why. They should also use the audit as a tool for comparing themselves with trusts delivering the best outcomes and to see where they can improve the care they offer to their cancer patients.”

Clinical director of the Royal College of Physicians' Clinical Effectiveness and Evaluation unit Jonathan Potter said:

“The data from the audit provides a unique and increasingly detailed picture of how care is provided for people with lung cancer and how it could be better.

“The challenge is now to drive change for improvement. To that end the College is delighted to have been able to fund a research fellow to assist in exploring the data in more detail and to be working with the national lung cancer audit team and the Health Foundation on a specific project to improve local care delivery.”

Medical director of the Roy Castle Lung Cancer Foundation Dr Jesme Fox said:

''The information in this audit is vital in assessing how lung cancer patients are treated in the NHS. We applaud the high quality of the data. However, the massive geographical variation in access to active anti cancer treatment, especially surgery, is very worrying. Patients deserve better. These differences urgently need to be explored and rectified. Next year's audit, we hope, will show a marked improvement".

The report is available at www.ic.nhs.uk/canceraudits/lung

Notes to editors

1. The National Lung Cancer Audit is commissioned and funded by the Healthcare Quality Improvement Partnership on behalf of the Department of Health and is run by The NHS Information Centre in partnership with the Clinical Effectiveness and Evaluation Unit at the Royal College of Physicians London. Since the audits started in 2003, details of over 100,000 patients diagnosed with lung cancer have been entered onto the database.
2. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 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 Information Centre also produces a wide range of 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.
3. The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. It is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nurses and the National Voices.
   
   HQIP has been commissioned by the Department of Health to manage the National Clinical Audit Programme. The programme currently comprises more than 20 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. 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.
4. The 2009 audit looks at patients diagnosed with lung cancer or mesothelioma who were first seen in 2008. Every trust in England and Wales, and every Health Board in Scotland has participated in the audit at some stage since its initiation. Three English trusts did not participate in the current audit period.
   
   The Scottish lung cancer dataset (excluding mesothelioma) has been collected for a number of years and this is the second year that the three Scottish networks have contributed data. Because of differences in reporting schedules, standards and targets the Scottish data are tabulated separately.
   
   All data presented refers to cases submitted to the National Lung Cancer Audit unless otherwise stated.
5. The audit has collected data on 32,447 patients in Great Britain for this audit period, representing over 85 per cent of the expected number of lung cancer cases. This represents approximately 94 per cent of cases presenting to secondary care (compared to the ‘expected number' of cases per trust, derived from historic cancer registry data and agreed with individual organisations). By the end of June 2008, all cancer networks in England, Wales and Scotland were contributing to the audit.
6. For further information, call the media team on 0845 257 6990.