Results from the first National Lung Cancer Organisational Audit.

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Presentation transcript:

Results from the first National Lung Cancer Organisational Audit. I Woolhouse1 K Greenaway2 C Meace2 P Beckett1 MD Peake1 1. Royal College of Physicians 2. Health & Social Care Information Centre

Background Lung cancer outcomes are improving Significant variation persists Not wholly explained by case-mix Organisational factors may play a part For example 1.5 times more likely to get surgery if first seen in surgical centre and twice as likely to get any active treatment if seen by lung nurse specialist.

Methods Electronic survey Jan 2014 All lung cancer leads England & Wales 7 questions for all MDTs 3 questions for Treatment Centres Two reminders Survey closed May 2014

Results 174 Trusts contacted 128 records completed 2 blank 8 duplicates 6 merged (same trust different hospital) 101 records analysed

Participation by strategic clinical network

Number of patients discussed at MDTM East Kent Hospital 88 cases per MDT meeting n=96 (excludes treatment only centres)

Diagnostics availability n=93 (8 trusts did not complete this section)

Lung CNS availability n=87 (excludes treatment-only centres)

Therapeutics availability n=93 (8 trusts did not complete this section)

Thoracic surgeon allocation n=73 (excludes treatment-only & thoracic surgical centres)

Thoracic oncologist allocation n=58 (excludes treatment-only and radiotherapy centres)

Treatment centres responses Thoracic surgery (n=16) Thoracic surgeons 2.25 (0.5-6.0) Theatre sessions per week 5.5 (1-18) HDU beds 9.0 (0-24) Cardiac surgery on site 88% Pulmonary rehab on site 75% Data presented as median (range) unless otherwise specified

Treatment centres responses Chemotherapy (n=79) Radiotherapy (n=31) Oncologists on site 1 (0-4) 2 (0.5-6) Chemo/RT nurses 4 (0-17) 2 (0-6) Acute oncology on site 92% 87% Data presented as median (range) unless otherwise specified

Conclusions Excessive numbers discussed at some MDTM Unacceptable variation in CNS workload Gaps in key diagnostics Unacceptable variation in allocation of treatment specialists Gaps in key treatment modalities

Limitations Only moderately representative Gaps/inconsistencies in data Responses not validated

Recommendations Encourage trusts to adopt best practice e.g. separate diagnostic MDT Lung cancer CRF to recommend NHS England commision more equitable allocation of resource Repeat in 2 years with improved methodology & participation