Network Audit Patients with Confirmed Small Cell Lung Cancer Who Did Not Receive Chemotherapy Dr D N Leitch On Behalf of Lung Cancer NSSG NECN

Introduction National Lung Cancer Audit - “Chemotherapy rates for small cell lung cancer below the England and Wales average of 65 per cent should be reviewed” Important clinical line of enquiry used in Peer Review Required consideration in annual self assessment report If gone as far as confirming diagnosis – Why no treatment?

NLCA Results 2010 Patients Code Actual number Number of patients small cell lung cancer % small cell receiving chemotherapy RE % RLN % RNL % RR % RTD % RTF % RTR % RVW % RXP % N36 Total2, % LUCADA Total 32,3473, %

Methods Retrospective case note audit All Trusts participated Patients diagnosed with lung cancer during 12 months to Results match the current 2011 National Lung Cancer Audit (NLCA) report for 2010 patients Results submitted to NECN, collated and analysed

Number of Cases in Audit vs Expected Trust (N36) Number of Cases Small Cell Small Cell Chemotherapy Rate Expected Number in Audit Number in Audit RE %6 RLN3369.7%108 (80%) RNL3452.9%169 (56%) RR %87 (88%) RTD4374.4%119 (82%) RTF3857.9%168 (50%) RTR4759.6%1915 (79%) RVW2965.5%107 (70%) RXP4562.2%1717 (100%) National %11380 (71%) NECN3, %2334

Results Patient characteristics Investigation Treatment

Median Age = 74 years (IQR 66-90)

CT Performed and MDT Discussion

Survivors >100 days vs All Patients >100 days survivalAll Median Age (IQR)78.5 (70-90)74.0 (66-90) M:F5:11 (45%)30:49 (38%) Co-morbidity14:2 (87.5%)57/80 (71%) Stage 3b,412/16 (75%)69/80 (75%) Performance Status 3,48/16 (50%)51/80 (64%) Chemotherapy discussed14/15 (88%)62/77 (81%) Chemotherapy refused7/10 (70%)20/57 (35%) Seen by Oncologist10/16 (63%)47/79 (60%) Treated with radiotherapy10/16 (63%)22/47 (46%)

Conclusions NLCA data collection is improving each year – Good quality comprehensive data important Process of audit is most valuable in reflecting on current practice – Surgical resection, histological confirmation, SCLC Chemotherapy Actual figures in audit are not the figures reported in NLCA – pre- upload review may significantly improve NLCA data values Almost all patients discussed at MDT meetings Almost all patients had a CT

Conclusions Median age was 74 years Too many (44%) presented as emergencies vs 41% as 2WR Too many had poor WHO PS – 64% WHO = 3 or 4 Significant Co-morbidity 71% 81% Chemotherapy discussed with patient 25% patients refused chemotherapy 60% seen by oncologist If no chemotherapy – about 25% had radiotherapy Longer survivors – older, more co-morbidity, better WHO-PS more likely to refuse chemotherapy

Actions Review data before uploaded if possible Ensure older patients with co-morbidity and better WHO – PS have full discussion, offer of chemotherapy and review with oncology - Other suggestions?