Quality statement 5: Treatment with curative intent

Quality statement

Adults with non-small-cell lung cancer stage I or II and good performance status have treatment with curative intent. [new 2019]

Rationale

Treatment with curative intent improves survival. There are a variety of options for treatment with curative intent in adults with stage I or II non-small-cell lung cancer who are well enough. Decisions about these treatment options should be taken at multidisciplinary team meetings that include all specialist core members. Adults with lung cancer should be involved in deciding which treatment or combinations of treatment best suit them.

Quality measures

Structure

a) Evidence that lung cancer multidisciplinary team meetings include all specialist core members.

Data source: Local data collection, such as attendance monitoring for lung cancer multidisciplinary team meetings.

b) Evidence of local processes for discussing options for treatment with curative intent with adults with stage I or II non-small-cell lung cancer and good performance status.

Data source: Local data collection, such as local clinical protocols and patient information resources.

c) Evidence of local arrangements and written clinical protocols to ensure that adults with non-small-cell lung cancer stage I or II and good performance status have treatment with curative intent.

Data source: Local data collection, such as local clinical protocols.

Process

Proportion of adults with non-small-cell lung cancer stage I or II and good performance status who have treatment with curative intent.

Numerator – the number in the denominator who have treatment with curative intent.

Denominator – the number of adults with non-small-cell lung cancer stage I or II and good performance status.

Data source: Royal College of Physicians National Lung Cancer Audit uses data from National Cancer Registration and Analysis Service Cancer Outcomes and Services Dataset on people with non-small-cell lung cancer stage I or II and performance status 0 to 2 receiving treatment with curative intent.

Outcome

a) Proportion of adults with non-small-cell lung cancer stage I or II and good performance status who are satisfied that treatment options were explained to them.

Numerator – the number in the denominator who are satisfied that treatment options were explained to them.

Denominator – the number of adults with non-small-cell lung cancer stage I or II and good performance status.

Data source: Local data collection, for example, a survey of adults with non-small-cell lung cancer or their families and carers.

b) 1-year survival rate for adults with non-small-cell lung cancer stage I or II.

Data source National Cancer Registration and Analysis Service Cancer Outcomes and Services Dataset.

c) 5-year survival rate for adults with non-small-cell lung cancer stage I or II.

Data source: Local data collection, for example, audit of patient review records.

What the quality statement means for different audiences

Service providers (such as secondary and tertiary care) ensure that lung cancer multidisciplinary team meetings include all specialist core members to support decisions on treatment for adults with lung cancer. Service providers ensure that staff are trained to discuss the risks and benefits of treatment options with adults with stage I or II non-small-cell lung cancer and good performance status and to support shared decision making. Service providers ensure that all treatment options are available.

Healthcare professionals (such as members of lung cancer multidisciplinary teams) attend lung cancer multidisciplinary team meetings and advise on treatment options for adults with non-small-cell lung cancer. Healthcare professionals discuss the risks and benefits of treatment options with adults with stage I or II non-small-cell lung cancer and good performance status and support them to make decisions about treatment.

Commissioners (such as clinical commissioning groups) commission services that ensure that adults with non-small-cell lung cancer stage I or II and good performance status can receive treatment with curative intent. Commissioners ensure that services have expertise to support decisions about optimal treatment for adults with non-small-cell lung cancer and that all suitable treatment options are available.

Adults who are fit and have early-stage non-small-cell lung cancer are offered treatment that may cure their cancer. They discuss treatment options with a healthcare professional who explains the risks and benefits of the different options.

Source guidance

Lung cancer: diagnosis and management (2019) NICE guideline NG122, recommendations 1.4.20, 1.4.21, 1.4.24, 1.4.27, 1.4.34 and 1.4.35

Definitions of terms used in this quality statement

Treatment with curative intent for non-small-cell lung cancer

There are a variety of options for treatment with curative intent for adults with stage I or II non-small-cell lung cancer and good performance status. The approach to treatment will depend on the clinical stage of the tumour, the person's performance status, comorbidities and personal choice. The following options should be available, and the risks and benefits of the options that are suitable should be discussed with the person:

  • surgery – lobectomy, sublobar resection, bronchoangioplastic surgery, bilobectomy or pneumonectomy

  • radiotherapy – stereotactic ablative radiotherapy (SABR) or conventional or hyperfractionated radiotherapy

  • chemoradiotherapy

  • multimodality treatment (surgery, radiotherapy and chemotherapy in any combination)

[NICE's guideline on lung cancer, recommendations 1.4.20, 1.4.21, 1.4.24, 1.4.27, 1.4.32, 1.4.33, 1.4.34 and 1.4.35]

Good performance status

A measure of how well a patient can perform ordinary tasks and carry out daily activities. A good performance status in this context is defined as a World Health Organization (WHO) score of 0 to 2:

  • 0, able to carry out all normal activity without restriction

  • 1, restricted in strenuous activity but ambulatory and able to carry out light work

  • 2, ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours.

[NICE's 2011 full guideline on lung cancer, glossary (appendix 6) and Royal College of Physicians National Lung Cancer Audit]

Equality and diversity considerations

Healthcare professionals should ensure that people with non-small-cell lung cancer are not excluded from treatment with curative intent because of their age. They should support older people to consider all the treatment options carefully before deciding which option suits them best.