There has been an “encouraging rise in survival” among patients with lung cancer, according to a major audit, but contact with nurse specialists remains too low.
At least 90% of all patients should be seen by a lung cancer nurse specialist and 80% should also have one present at the time of diagnosis, but last year only 57% of patients were seen by a nurse.
“Highlights include the improvement in pathological sub-typing… and probably most importantly the improvement in one-year survival”
The National Lung Cancer Audit report for 2016, published this week, covers patients first diagnosed in 2015, and includes 36,025 patients in England, 2,207 in Wales, 37 in Guernsey and 4,884 in Scotland.
Regarding nursing care for lung cancer patients, the report said: “The importance of the specialist nurse cannot be over-emphasised and, as in previous years, we strongly promote this role.”
It noted that, according to the data for 2015, 84% of the total patients included in the audit were seen by a specialist nurse, and 65% in England had a nurse present at the time of diagnosis.
The auditors recommend that at least 90% of patients were seen by a lung cancer nurse specialist and at least 80% of patients should have one present at diagnosis.
However, the audit report warned that during 2016 only 57% of patients, overall, were recorded to have been seen by a lung cancer nurse specialist.
“We implore all lung cancer units to critically review their results”
But it also criticised information recording standards in the area, saying data completion for the involvement of nurses was “highly variable and, as a result, it is difficult to interpret”.
In Wales, 97% of cases had data, and overall 91% of patients were seen by a specialist nurse. In Guernsey, 100% of cases had data, but only 22% of patients were seen by a nurse.
Probably due to a new collection method, the data from English trusts was only recorded in 60% of cases, said the report, adding that the results suggested 55% of patients were seen by a nurse.
But it cautioned that data on whether a nurse was present at the time of diagnosis – only collected in England at present – was judged too incomplete to be interpreted.
Overall, the audit report stated that the results for data completeness on having been seen by a lung cancer nurse specialist were “not as high as we would like”.
“This data item requires ongoing communication between the nursing and cancer data teams to ensure that it is collected and recorded consistently,” according to the report. It added: “Specialist nurses need to work with their data managers to ensure that the data accurately reflect their activity.”
“It is really important that we monitor services and lung cancer patient outcomes”
For the coming year, the report restated the recommendation that at least 90% of patients were seen by a specialist nurse and at least 80% should have one present at the time of diagnosis.
However, the overall message from the report was positive, said the authors, revealing a 7% increase in the number of people diagnosed with lung cancer surviving for longer than one year.
The report said measurement of survival showed “encouraging improvements”, with one-year survival at 38%, compared with 31% in its 2010 audit.
The “clear increase” in one-year survival in the five-year period from 2010 to 2015 reinforced earlier findings published at the end of 2016, noted the report published by the Royal College of Physicians.
Meanwhile, it also revealed that 60% of lung cancer patients received anti-cancer treatments, such as chemotherapy, radiotherapy or surgery – meeting a target set out in the 2015 audit report.
For example, there was a significant rise in the proportion of patients with advanced non small-cell lung cancer who received chemotherapy, from 48% in 2008 to 64% in 2015.
In addition, the number of cases with a pathological confirmation saw an uplift to 72% from 69% in the 2015 report, with the number of cases where the subtype could not be determined falling to 11% and continuing a historical trend seen over the past few years.
Too few lung cancer patients seeing specialist nurse
Despite the “obvious good news”, there continued to be regional variation in the survival rates and types of treatments that patients were offered, noted the audit report. It highlighted that “work must be done to ensure that all patients are consistently provided with the best possible care”.
It made recommendations for improvements in three main areas – data completeness, process of care, and treatment and outcomes. For example, the report described “some aspects of data completeness results” as having been “disappointing” – including that for nursing but also for other areas.
It said, overall, 75% of patients had performance status recorded in England, which meant the target of 90% was not met. Across individual organisations, the results varied from 0% to 100%, it said.
Other recommendations included that where pathological confirmations were below 80% they should be reviewed to ensure that best practice had been followed.
Meanwhile, multi-disciplinary teams with anticancer treatment rates of below 60% should conduct detailed case-note reviews to identify why patients did not receive anticancer treatment.
In addition, teams with one-year survival rates of less than 38% should review their diagnostic and treatment pathways to ensure that all patients are diagnosed promptly and treated appropriately.
Dr Ian Woolhouse, the audit’s senior clinical lead, said: “It is very encouraging to note that overall many of our audit indicators have improved compared to the last report.
“Highlights include the improvement in pathological sub-typing of lung cancer, the use of chemotherapy and surgery in non-small cell lung cancer, and probably most importantly the improvement in one-year survival,” he said.
Too few lung cancer patients seeing specialist nurse
“However, there is still much work to do to ensure that all lung cancer patients receive a standard of care that is equal to the best in the country and we implore all lung cancer units to critically review their results and work with our quality improvement team to achieve this,” he added.
Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, described the audit as a “great source of information on lung cancer”.
“It is really important that we monitor services and lung cancer patient outcomes, in a timely manner,” she said. “This audit allows us to do that.
“We are pleased to see this encouraging increase in patient survival. However, there is much still to do, to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care,” she added.