National Lung Cancer Audit Context Page

The National Lung Cancer Audit looks at the care delivered during referral, diagnosis, treatment and outcomes for people diagnosed with lung cancer and mesothelioma. The audit is run by the Royal College of Physicians. The metrics do not apply to 6 Tertiary ‘treatment only’ centres which do not provide primary diagnostic services for lung cancer patients (The Christie NHS FT, The Clatterbridge Cancer Centre NHS FT, Papworth NHS FT, University Hospital of South Manchester NHS FT, The Royal Marsden NHS FT and The Royal Brompton and Harefield NHS FT).

Audit website: http://content.digital.nhs.uk/lung

Metrics

Case ascertainment

All trusts in England participate in the audit, and data is submitted for approximately 100% of patients. Case ascertainment is therefore not presented separately.

1. Crude proportion of patients seen by a Cancer Nurse Specialist (CNS)

• Rationale: access to a CNS is associated with an improved patient experience and with improved access to anti-cancer treatments. This metric is known to vary across regions.
• Guideline/mapping: this metric maps exactly to NICE QS 17, statement 4 and to NICE CG 121, section 1.2.2; based on this, the audit specifies a minimum standard of ≥ 80% and an aspirational threshold of 90%.
• Graph/relative performance: simple RAG scale; hospitals have been compared numerically against the minimum standard; ‘green triangle’ means that the hospital’s performance is better than the minimum standard, ‘red circle’ means that the hospital’s performance is worse than the minimum standard.
• Quality improvement prompt question: ‘red circle status for a hospital should prompt questions about the quality of and ease of access to a CNS for patients diagnosed with lung cancer and what actions the hospital is taking to improve this.

2. Case mix adjusted one-year relative survival rate (for all patients, from time of diagnosis of lung cancer)

• Rationale: treatment of lung cancer aims to prolong survival and improve quality of life by improving symptoms. The proportion of patients alive at 1 year from diagnosis is a marker of treatment success in lung cancer. This metric is known to vary across regions; a case-mix adjustment has been performed for comparative analysis.
• Guideline/mapping: this metric maps approximately to NICE CG 121 (full guideline), page 14; mapping is approximate because the evidence underpinning the guideline describes contemporary 1-year survival rates including EUROCARE-4 data but the guideline does not itself make recommendations on 1-year survival rates; the audit does not currently specify an aspirational threshold.
• Graph/relative performance: case-mix adjusted statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate; grey square’ means that there is no statistically significant difference between them; ‘yellow hexagon’ means the hospital’s performance is statistically significantly worse than expected; ‘red circle’ means that the hospital’s performance is statistically very significantly worse than the national average.
• Quality improvement prompt question: ‘yellow hexagon’ and ‘red circle’ (significantly worse) status should prompt questions about actions which the Trust is taking to improve the survival of patients diagnosed with lung cancer.

3. Case mix adjusted percentage of patients with Non Small Cell Lung Cancer (NSCLC) receiving surgery

• Rationale: surgery offers the best chance of curing lung cancer and there is evidence linking higher surgical resection rates with longer survival. This metric is known to vary across regions. Measuring resection rate in only histologically-confirmed cases is the approach taken internationally.
• Guideline/mapping: this metric maps exactly to NICE QS 17, statement 9. It also approximates to statement 8 and to NICE CG 121, sections 1.4.20-1.4.23 and section 1.4.48; mapping is approximate because the guidelines refer to appropriate multimodality treatment for certain sub-groups of patient without specifying a minimum numerical standard applicable to all patients; the audit does not currently specify an aspirational threshold.
• Graph/relative performance: case-mix adjusted statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate; grey square’ means that there is no statistically significant difference between them; ‘yellow hexagon’ means the hospital’s performance is statistically significantly worse than expected; ‘red circle’ means that the hospital’s performance is statistically very significantly worse than the national average.
• Quality improvement prompt question: ‘‘yellow hexagon’ and ‘red circle’ (significantly worse) status should prompt questions about the quality of referral pathways and diagnostic services for suspected lung cancer, access to the specialist cancer network MDT as well as actions which the Trust has taken to improve the proportion of patients receiving surgery.

4. Case mix adjusted percentage of fit patients with advanced NSCLC (NSCLC) receiving Systemic Anti-Cancer Treatment (defined as patients with performance status 0-1 and stage IIIB-IV NSCLC)

• Rationale: for fitter patients with incurable NSCLC, chemotherapy is known to extend life expectancy and improve quality of life; treatment rates are known to vary widely across regions; note – although a crude proportion is presented, case-mix adjustment has been performed for comparative analysis.
• Guideline/mapping: this metric maps exactly to NICE QS 17, statement 9. It approximates to statement 12 and NICE CG 121, section 1.4.40; mapping is approximate because the guidelines refer to appropriate multimodality treatment for certain sub-groups of patient without specifying a minimum numerical standard applicable to all patients; based on this, the audit specifies a minimum standard of ≥60%.
• Graph/relative performance: case-mix adjusted statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate; grey square’ means that there is no statistically significant difference between them;  ‘yellow hexagon’ means the hospital’s performance is statistically significantly worse than expected; ‘red circle’ means that the hospital’s performance is statistically very significantly worse than the national average.
• Quality improvement prompt question: ‘yellow hexagon’ and ‘red circle’ (significantly worse) status should prompt questions about the effectiveness of the regional cancer network MDT and the efficiency of referral pathways for oncological treatment as well as actions which the Trust is taking to improve the proportion of fit patients with advanced NSCLC receiving chemotherapy.

5. Case mix adjusted percentage of patients with Small Cell Lung Cancer (SCLC) receiving chemotherapy (for all patients with SCLC)

• Rationale: SCLC responds well to chemotherapy but this benefit depends on prompt treatment whilst patients are still fit enough to receive it; treatment rates are known to vary widely across regions; note – although a crude proportion is presented, case-mix adjustment has been performed for comparative analysis.
• Guideline/mapping: this metric maps exactly to NICE QS 17, statement 9. It approximates to statement 13 and to NICE CG 121, sections 1.4.45 and 1.4.49; mapping is approximate because the guidelines refer to appropriate multimodality treatment for certain sub-groups of patient without specifying a minimum numerical standard applicable to all patients; based on these guidelines, the audit specifies a minimum standard of ≥70%.
• Graph/relative performance: case-mix adjusted statistical RAG scale; hospitals have been compared against the national aggregate using a statistical test; ‘green triangle’ means that the hospital’s performance is statistically significantly better than the national aggregate; grey square’ means that there is no statistically significant difference between them: ‘yellow hexagon’ means the hospital’s performance is statistically significantly worse than expected; ‘red circle’ means that the hospital’s performance is statistically very significantly worse than the national average.
• Quality improvement prompt question: ‘yellow hexagon’ and ‘red circle’ (significantly worse) status should prompt questions about the effectiveness of the regional cancer network MDT and the efficiency of referral pathways for oncological treatment as well as actions which the Trust is taking to improve the proportion of patients with SCLC receiving chemotherapy.