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Lung cancer: the diagnosis and treatment of lung cancer [CG121]

Measuring the use of this guidance

Recommendation: 1.2.1

Find out what the patient knows about their condition without assuming a level of knowledge. Provide patients with the opportunity to discuss tests and treatment options in a private environment, with the support of carers, and time to make an informed choice. [new 2011]

What was measured: Proportion of lung cancer patients who reported being told they could bring a family member or friend with them when they were first told they had cancer.
Data collection end: June 2015
70.1%
Data collection end: June 2016
75%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.


Recommendation: 1.2.2

Ensure that a lung cancer clinical nurse specialist is available at all stages of care to support patients and carers (new 2011)

What was measured: Seen by lung cancer nurse specialist (England and Wales)
Data collection end: July 2009
64.4%
Data collection end: July 2010
75.4%
Data collection end: July 2011
79.6%
Data collection end: December 2012
82.3%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: Nurse specialist present at diagnosis (England and Wales)
Data collection end: July 2009
38.3%
Data collection end: July 2010
38%
Data collection end: July 2011
58%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: Proportion of lung cancer patients who reported that they were given the name of a Clinical Nurse Specialist who would support them through their treatment.
Data collection end: June 2016
90.8%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Assessed by lung cancer nurse specialist (England only).
Data collection end: December 2016
70.3%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.2.2

Ensure that a lung cancer clinical nurse specialist is available at all stages of care to support patients and carers. [new 2011]

What was measured: Proportion of lung cancer patients who reported that they were given the name of a Clinical Nurse Specialist who would support them through their treatment.
Data collection end: June 2015
91%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Seen by lung cancer nurse specialist.
Data collection end: December 2014
77.5%
Data collection end: December 2015
54.8%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: Lung cancer nurse specialist present at diagnosis (England only).
Data collection end: December 2016
57.8%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.2.3

Offer accurate and easy-to-understand information to patients and their carers. Explain the tests and treatment options, including potential survival benefits, side effects and effect on symptoms. [new 2011]

What was measured: Proportion of lung cancer patients who reported that, before their cancer treatment started, their treatment options were explained to them "completely" or there was only one type of treatment that was suitable for them.
Data collection end: June 2015
85.5%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of lung cancer patients who reported that the possible side effect(s) of treatments were explained to them in a way they could understand "completely".
Data collection end: June 2015
72.2%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of lung cancer patients who reported that, before their cancer treatment started, their treatment options were explained to them "completely" or there was only one type of treatment that was suitable for them.
Data collection end: June 2016
84.8%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.

What was measured: Proportion of lung cancer patients who reported that the possible side effect(s) of treatments were explained to them in a way they could understand "completely".
Data collection end: June 2016
71.3%
Area covered: England
Source: Quality Health. National Cancer Patient Experience Survey.


Recommendation: 1.3.4

Ensure all patients potentially suitable for treatment with curative intent are offered PET-CT before treatment. [new 2011]

What was measured: Proportion of patients starting radical radiotherapy for NSCLC that were positron emission tomography/computed tomography (PET/CT) staged.
Data collection end: December 2013
96%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.3.8

Offer EBUS-guided TBNA for biopsy of paratracheal and peri‑bronchial intra-parenchymal lung lesions. [new 2011]

What was measured: Proportion patients starting radical radiotherapy for NSCLC where endobronchial ultrasound (EBUS) was used to sample lymph nodes.
Data collection end: December 2013
67%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.3.13

Chest CT should be performed before: • an intended fibreoptic bronchoscopy • any other biopsy procedure. (2005)

What was measured: CT performed before bronchosopy (England and Wales)
Data collection end: July 2009
80.7%
Data collection end: July 2010
84.8%
Data collection end: July 2011
87.8%
Data collection end: December 2012
89.6%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: CT performed before bronchosopy.
Data collection end: December 2015
91%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.3.26

Consider MRI or CT of the head in patients selected for treatment with curative intent, especially in stage III disease. [new 2011]

What was measured: Proportion of hospitals that routinely brain imaged stage IIIa lung cancer patients.
Data collection end: May 2014
83%
Area covered: England
Source: Hudson BJC (2015) Brain imaging in lung cancer patients without symptoms of brain metastases: A national survey of current practice in England. Clinical Radiology.


Recommendation: 1.3.32

The care of all patients with a working diagnosis of lung cancer should be discussed at a lung cancer MDT meeting

What was measured: Patient discussed at MDT (England + Wales)
Data collection end: July 2009
94.1%
Data collection end: July 2010
96.4%
Data collection end: July 2011
96.2%
Data collection end: December 2012
95.8%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: Patient discussed at MDT (England only).
Data collection end: December 2014
93.6%
Data collection end: December 2015
81.7%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.

What was measured: Patient discussed at MDT (England only).
Data collection end: December 2016
87.5%
Number that met the criteria: 32157 / 36758
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.4.2

Advise patients to stop smoking as soon as the diagnosis of lung cancer is suspected and tell them why this is important. [new 2011]

What was measured: Proportion of patients starting radical radiotherapy for NSCLC that were given smoking cessation advice.
Data collection end: December 2013
57%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.4.3

Offer nicotine replacement therapy and other therapies to help patients to stop smoking in line with Smoking cessation services (NICE public health guidance 10) and Varenicline for smoking cessation (NICE technology appraisal guidance 123). [new 2011]

What was measured: Proportion of providers with access to smoking cessation services.
Data collection end: December 2016
67%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.4.13

Perform spirometry in all patients being considered for treatment with curative intent. Measure TLCO if breathlessness is disproportionate or there is other lung pathology (for example, lung fibrosis). [new 2011]

What was measured: Proportion of patients starting radical radiotherapy for NSCLC that have forced expiratory volume in 1 second (FEV) available.
Data collection end: December 2013
82%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.4.27

Patients with stage I or II NSCLC who are medically inoperable but suitable for radical radiotherapy should be offered the CHART regimen. [2005]

What was measured: Proportion of stage I or II patients starting radical radiotherapy for NSCLC that were offered CHART.
Data collection end: December 2013
26%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.4.29

Patients with stages IIIA or IIIB NSCLC who are eligible for radical radiotherapy and who cannot tolerate or do not wish to have chemoradiotherapy should be offered the CHART regimen. [2005]

What was measured: Proportion of stage III patients starting radical radiotherapy for NSCLC that were not suitable for chemoradiotherapy that were considered for CHART.
Data collection end: December 2013
31%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.4.32

Consider chemoradiotherapy for patients with stage II or III NSCLC who are not suitable for surgery. Balance potential benefit in survival with the risk of additional toxicities. [new 2011]

What was measured: Proportion of stage III patients starting radical radiotherapy for NSCLC that were considered for chemoradiotherapy.
Data collection end: December 2013
64%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.


Recommendation: 1.4.40

"Chemotherapy should be offered to patients with stage III or IV NSCLC and good performance status (WHO 0, 1 or a Karnofsky score of 80–100), to improve survival, disease control and quality of life. [2005]"

What was measured: Proportion of patients with stage IIIB/IV, performance status 0-1, NSCLC who had chemotherapy (England only).
Data collection end: December 2016
62.5%
Number that met the criteria: 4214 / 6746
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.4.41

Chemotherapy for advanced NSCLC should be a combination of a single third-generation drug (docetaxel, gemcitabine, paclitaxel or vinorelbine) plus a platinum drug. Either carboplatin or cisplatin may be administered, taking account of their toxicities, efficacy and convenience. [2005]

What was measured: Proportion of patients with stage IIIB/IV, performance status 0-1, NSCLC who had systemic anticancer treatment, who received gemcitabine and carboplatin (England only).
Data collection end: December 2016
20.6%
Area covered: National
Source: Royal College of Physicians. National lung cancer audit.


Recommendation: 1.6.1

Offer all patients an initial specialist follow-up appointment within 6 weeks of completing treatment to discuss ongoing care. Offer regular appointments thereafter, rather than relying on patients requesting appointments when they experience symptoms. [new 2011]

What was measured: Proportion of radical radiotherapy NSCLC patients that had their first planned follow up within 6 weeks.
Data collection end: December 2013
99%
Area covered: UK
Source: McAleese J, McAleese J. (2015) The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK. Clinical Oncology (Royal College of Radiologists) 27 (9): 498-504.



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