Lung cancer is the third most common cancer and is the leading cause of cancer death in England. In 2017, there were almost 39,000 new cases of lung cancer and just over 28,000 related deaths.

This report considers how NICE’s evidence based guidance can contribute to improvements in the care of people with lung cancer.

Published November 2019

Prevention of lung cancer

Most lung cancers are associated with smoking. The number of people who smoke has been dropping over the last 4 decades, but more can be done to help people stop.

Recognition of lung cancer

NICE recommends public awareness campaigns to boost recognition of the signs and symptoms of lung cancer, including in those who have never smoked. Combined with faster referral this has led to more people being seen by a specialist within the recommended 2 weeks. 

Diagnosis and staging

Advances in diagnostic capabilities has led to increased use of tumour markers and more pathological confirmations. This allows for more decisions around prognosis and targeted treatment options. 

Treatment

More people are receiving treatment for lung cancer, with surgery rates for non-small-cell lung cancer (NSCLC) having doubled since 2009.

Patient experience

Survey results suggest that most people with lung cancer have a positive experience of care overall, but there is room for improvement. Improving communication and ensuring the availability of specialist nurses can help to achieve this. 

Commentary

Professor Michael Peake reviews recent achievements and considers NICE's role in improving outcomes for people with lung cancer. 

This report highlights progress made by the health and care system in implementing NICE guidance. We recognise that change can sometimes be challenging and may require pathway reconfiguration. Additional resources such as training and new equipment may also be required.

We work with partners including NHS England, Public Health England and NHS Improvement to support these changes, and we also look for opportunities to make savings by reducing ineffective practice.


Why focus on lung cancer?

NICE impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system, helping to improve outcomes where this is needed most.

Since 2005 and the publication of NICE’s first guideline on lung cancer, we have produced a suite of lung cancer related guidance, which aim to improve outcomes by focusing on survival rates and ensuring the most effective tests and treatments are used.

In England, overall survival rates for cancers are improving but there is still a marked difference between lung cancer and other cancers. Between 2012 and 2016 more than 95% of people with breast or prostate cancer survived more than 1 year after their diagnosis, compared to less than 40% of people with lung cancer.

There is an even greater difference between 5-year survival rates. More than 85% of people with breast or prostate cancer survived more than 5 years but just over 15% of people with lung cancer survived this long. When comparing with other countries in Europe, England’s long-term survival for people with lung cancer is poor, ranking 26th out of 29 countries.

Acknowledging this, the NHS Long Term Plan focuses on the faster diagnosis of all cancer in order for people to have the best chance of curative treatment and improve long-term survival. This is set out with several milestones with the aim of diagnosing 75% of cancers at stage 1 or 2 by 2028.

We routinely collect data which give us information about the uptake of our guidance. To produce this report, we have worked with national partners to select those data which tell us how NICE guidance might be making a difference in priority areas of lung cancer care. They also highlight areas where there is still room for improvement.