'Unacceptable' Variations in Lung Cancer Survival Rates

Peter Russell

November 22, 2018

Despite improvements in 5-year survival rates for lung cancer, "unacceptable variations" persist across England, according to a new report.

Results showed that only 27% of lung cancer patients in England receive a diagnosis at stage I or II, and just 72.6% get treated within the current 62-day national cancer waiting time standard.

The UK Lung Cancer Coalition (UKLCC), which compiled the report, said too many patients faced delays in treatment based on their location.

'Unwarranted' Delays

"Three out of 4 people with lung cancer are diagnosed too late to be suitable for potentially curative treatment," said Prof Mick Peake, clinical director at the Centre for Cancer Outcomes, Cancer Collaborative, University College London Hospitals. "Unwarranted delays in treatment, even at the early stages, can allow a tumour to grow by just a few millimetres which can have a dramatic effect on someone's chance of survival."

Five-year survival rates have consistently lagged behind many European countries. England currently ranks 26th out of 29 countries. For patients diagnosed in 2011, only 14% of males and 17.5% of females survived for 5 years.

Long-term survival rates were even worse in Scotland, ranked 27th out of 29 European countries, and Wales, ranked 28th. Northern Ireland fared better, with a ranking of 19th.

The National Lung Cancer Audit (NLCA) for the 2016 period found geographical variations across England on a number of key measures, including:

  • Surgery rates in all non-small cell lung cancer (NSCLC): Eighteen organisations were identified as having better surgical resection rates than the national average, but 60 organisations failed to meet the audit standard of 17%

  • Systemic anti-cancer treatment (SACT) rates in NSCLC (stage IIIB/IV and performance status 0-1): Overall, 62% of patients with good performance status and advanced NSCLC received SACT, but 85 organisations failed to achieve the standard

  • Curative intent treatment rates for stage I-II NSCLC (performance status 0-2): Overall, 80.4% of patients with early stage disease and good performance status received treatment with curative intent, but 1 in 5 such patients did not receive treatment with curative intent, and across individual organisations the rate of treatment with curative intent varied from 54.5% to 100%

The UKLCC report, Millimetres Matter , called for local cancer services to implement the National Optimal Lung Cancer Pathway (NOLCP). The NHS England initiative advocates a standardised care pathway for lung cancer patients wherever they live, as well as faster access to diagnostic tests and treatment, and reduced waiting times.

The UKLCC believes that putting the NOLCP into action, would help achieve its ambition of boosting 5-year UK lung cancer survival to 25% by 2025.

The pathway is also available to clinicians in Wales, Scotland, and Northern Ireland.

Research has suggested a 16% increase in mortality if the time from lung cancer diagnosis to having surgery is more than 40 days, the UKLCC said. Its chairman, Richard Steyn, consultant thoracic surgeon, and deputy medical director at University Hospitals Birmingham NHS Foundation Trust, commented: "A delayed diagnosis means patients having their worst fears dragged out, with thousands of people being left in an appalling state of limbo."

Single Suspected Cancer Pathway for Wales

The Welsh Government announced today that it would introduce a single suspected cancer pathway to improve treatment times. The new pathway would start from a point where a patient is suspected of having cancer, rather than when the cancer is confirmed.

It is intended that treatment should start no later than 62 days from the point of suspicion, Vaughan Gething, the Welsh Health Secretary, said.

The pathway would be supported with a £3 million investment from the Welsh Government in the next financial year.

Andy Glyde, Cancer Research UK's public affairs manager in Wales, said: "Cancer waiting times are a barometer for how the NHS is performing and this new system is welcome as it will give us a clearer picture of what is happening for patients going through a cancer diagnosis."
 

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