Professor Michael Peake
In England the average 5-year survival rate for people diagnosed with lung cancer between 1991 and 1993 was 5% but varied by Area Health Authority between 2% and 8.5%. The latest figures from the Office for National Statistics show that 5-year survival had tripled for people diagnosed in 2011 to 14% for males and 17.5% for females.
Before the National Cancer Plan and the NICE guidelines were published, cancer care was fragmented. The first NICE guideline on lung cancer was published in 2005, the same year that full data collection in the National Lung Cancer Audit (NLCA) began. Since then there has been the universal adoption of MDT working and a steady increase in the proportion of people receiving any active anti-cancer treatment, namely surgery, chemotherapy or radiotherapy. Of these, the most important explanation of the improvement in 5-year survival is likely to be the more than doubling of the number of people undergoing surgical resection of their cancers. The quality of surgery has also improved over that period, with significant falls in peri-operative mortality, to some of the lowest levels reported internationally, despite surgery being carried out on older, less fit patients. That has been achieved by a doubling of the number of specialist thoracic surgeons since 2005.
Professor Michael Peake is Clinical Director for the Centre for Cancer Outcomes and Honorary Professor of Respiratory Medicine at the University of Leicester
Outcomes for people with lung cancer are improving but there is still work to be done to reduce regional variation and ensure adequate staffing levels
This has all been accompanied by much better diagnostic and staging techniques and the unprecedented increase in knowledge of the basic science and emergence of personalised medicine, based on advances in molecular pathology.
The development of NICE’s referral guidelines for GPs and the rapid referral pathways, combined with all the work on public and primary care awareness, have been associated with an increase in the proportion of people diagnosed at stages I and II from 19.5% in 2012 to 28% in 2017. Evidence of the effectiveness of lung cancer screening is now strong and the emergence of screening programmes in England is likely to have a major long-term impact on survival and mortality rates.
However, as is well demonstrated by the NLCA, wide variation in treatment and survival rates remain between different areas of the country. Apart from the limitations of current treatments, the main barrier to further progress in England is a shortfall in workforce, particularly in radiology, pathology and oncology, although there are many examples where, with better organisation and design of services, improvements in both the timeliness and quality of care can be achieved within current resources. The aim should be to achieve universal and timely access to optimal care delivered by specialist teams as described in NICE guidance, which would result in further improvement in outcomes, both in terms of survival and quality of life, for people with lung cancer.