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Nearly 20 trusts ‘encouraged to review’ chemo practice

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Researchers from Public Health England have encouraged 19 health service trusts to review their practices surrounding chemotherapy, due to high mortality rates.

A new nationwide study, published this week, has set benchmarks for 30-day mortality following chemotherapy for breast and lung cancer in England

“Access to this real-world data is crucial for health professionals”

Jane Maher

For the first time, national data on 30-day mortality for patients with breast and lung cancer treated with chemotherapy have been collected and analysed in order to help clinical teams review and improve patient care, and identify groups of patients who may have additional needs.

The study, published in the Lancet Oncology, identified factors such as age and general well-being that affect 30-day mortality, as well as NHS trusts with higher than expected rates of mortality.

It included all breast and lung cancer patients who received one or more cycles of systemic anti-cancer therapy (SACT) in NHS trusts in England in 2014 – a total of 28,364 women with breast cancer and 15,045 men and women with lung cancer.

The researchers found 30-day mortality was 8.47% for patients with lung cancer and 2.47% for patients with breast cancer.

Mortality was higher for patients receiving palliative treatment – 10% for lung cancer and 7.48% for breast cancer – compared to patients receiving curative treatment – 2.88% for lung cancer and 0.26% for breast cancer.

“Some groups are at a substantially increased risk of 30-day mortality”

Study authors

Whereas SACT was previously only used to treat a small number of cancer types, the study authors noted that it was now used routinely in many patients with common cancers.

They found 30-day mortality was higher for patients receiving their first reported SACT treatment – whether curative or palliative – compared to those who had already received one or more cycles.

They also found 30-day mortality increased with age for both patients with breast or lung cancer treated with curative intent, and decreased with age for patients receiving palliative SACT.

The authors said this may be because older patients may favour other forms of palliative care over SACTs, or because younger patients might have more aggressive forms of cancer.

In addition, 30-day mortality was also generally higher for patients with worse general health, compared to those in better health.

Meanwhile, “several trusts” were found to have higher rates of 30-day mortality after SACT than expected, including seven for curative breast cancer, four for palliative breast cancer, five for curative non-small cell lung cancer (NSCLC) and seven for palliative NSCLC.

The authors said there may be a number of reasons why the trusts – which were not named in the study paper – were identified as outliers, including poor data management, poor clinical care or decision making.

“The identification of hospitals with significantly higher 30-day mortality rates should promote review of clinical decision making in these hospitals,” said the researchers.

They added that they had written to all trusts to inform them on their 30-day mortality status, encouraging them to review their practices.

Public Health England

Nearly 20 trusts ‘encouraged to review’ chemo practice

Jem Rashbass

Dr Jem Rashbass, study co-author and cancer lead at Public Health England, said. “This important study uses real clinical data, rather than trial data, from patients across the NHS to examine the quality of care and clinical decision making.

“Those hospitals whose death rates are outside the expected range have had the findings shared with them and we have asked them to review their practice and data,” he said.

He added: “Public Health England’s National Cancer Registration and Analysis Service will work with all trusts to help them understand the findings and the implications for their data collection and care.”

Professor Jane Maher, joint chief medical officer at Macmillan Cancer Support, said it was “concerning” that the risk of death following chemotherapy intended to cure non-small cell lung cancer was almost four times as high as previously thought.

She added: “Access to this real-world data is crucial for health professionals to help them better understand the delicate balancing act when comparing the risk of death or severe side effects and the potential increase in survival if chemotherapy is administered.

“It’s also important that patients are as well-informed as possible to help them make decisions around their treatment,” she said.

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