1. Delivery of systemic therapy in Gloucestershire for NSCLC
Nina Reeve
Fiona Young
Sam Guglani
Lung Cancer Business Meeting
Thursday 11th February 2016
Redwood Education Centre GRH

2. NICE Guidance 2011
Chemotherapy should be offered to patients with stage III or IV NSCLC and good performance status (WHO 0 or 1)
Chemotherapy for advanced NSCLC should be a combination of a single third-generation drug plus a platinum drug
Docetaxel, gemcitabine, vinorelbine

3. 10th National Lung Cancer Audit Report 2014 (2013 audit period)

4. 10th National Lung Cancer Audit Report 2014 (2013 audit period)
patients/ 100% secondary care lung cancer
Investigate chemo rates below England & Wales averages:
SCLC 70%
NSCLC 60% (PS 0/1 Stage IIIb/IV)

5. 10th National Lung Cancer Audit Report 2014 (2013 audit period)
patients/ 100% secondary care lung cancer
Investigate chemo rates below England & Wales averages:
SCLC 70% 62%
NSCLC 60% (PS 0/1 Stage IIIb/IV) 37%

6. 10th National Lung Cancer Audit Report 2014 (2013 audit period)
A self-assessment of the GH NHS FT lung cancer MDTs against the NICE lung cancer quality standards.
QS12
People with stage IIIB or IV non-small-cell lung cancer and eligible performance status are offered systemic therapy (first- and second-line) in accordance with NICE guidance, that is tailored to the pathological sub-type of the tumour and individual predictive factors.
Non-compliant – we have the lowest rate of this treatment of any trust in the South West, and the old 3-counties region had the lowest rate of any region in the whole country.
Action: An audit is urgently required to examine the underlying reasons for this.

7. Delivery of systemic chemotherapy in NSCLC
Audit
February 2016

8. Aim
Are we offering chemotherapy to stage 3b/4 NSCLC patients with a PS of 0/1 as per NICE guidance
Are we reaching the standards set by the 10th lung cancer audit

9. Method GHT and CGH Lung cancer MDTs All NSCLC registered in 2014
Stage 3b/4
PS 0/1 as documented by MDT
Opmas for registration clinic letters and chemotherapy regimes

10. Results GHT and CGH Lung cancer MDTs All NSCLC registered in 2014
Stage 3b/4
PS 0/1 as documented by MDT
Opmas for registration clinic letters and chemotherapy regimes
59 patients

11. Demographics
Sex
16%
40%
Fits with national demographics

12. Stage and Intent Stage Intent
How do these breakdown 3b. Why not concurrent/radical
KD 1 x chemo offered, frail PS 1. Joint decision that SE would be too detrimental to QoL. RT for symptoms
RS 1 x no chemo offered due to pain being predominant factor for referral so pallioative RT offered. No further documented meetings with onc as died 2 months later. 83 yrs weight loss
DF 1 x RT for pain. Chemo offered at progression but pt declined
RJ 1 x RT for pain. 80 yrs ?frail
1 x tarceva
3 x chemo (concurrent not discussed)

13. Performance status
6 pts were changed from PS 0/1 to a 2 or 3 and so were not eligible for further inclusion
PS not stated in 3 pts so excluded
50 patients
MDT PS highlighted 44 pts that were PS 0/1
Oncology found 50 at PS 0/1
MDT 1 to Onc 2 in 20 days (RT)
MDT 1 to onc 2 13 days
MDT 0 to Onc 3 in 8 days (WB)
MDT 1 to onc 3 in 1 day (EB)
MDT 1 to onc 3 and pt was seen 7 days before MDT discussion (AC)

14. Patient pathway Time from MDT discussion to seeing an oncologist;
Mean 15 days
22% were seen before MDT
Range 2-55 (2-26)
Time to receiving chemotherapy from 1st oncologist appointment
Mean 22 days
Range 8-53 days (8-39)
Time from MDT to receiving treatment
Mean 37 days
Range 2-55 days (2-39)

15. Chemotherapy and Systemic treatment5
(10%)
26 (52%)
62% pts received systemic therapy

16. Documented reason for no chemotherapy
53% received RT upfront for local symptoms including pain (8 received thoracic RT (2 refuse chemo, 1 had chemo subsequently), 3 received WBRT)
26% had an egfr mutation and received a TKI
16% had a change in their PS deeming them unfit for chemotherapy
4% had comorbidities

17. Survival (months)

18. Summary
52% of patients who were PS 0 or 1 at diagnosis received a platinum based chemotherapy
10% had other systemic treatment – TKI etc
62% of patients with PS 0/1 received systemic therapy
16% of pts that were PS 0/1 at diagnosis had deteriorated by the time they were due to begin chemotherapy
Those receiving primary RT for symptoms made up the largest group of patients not receiving immediate chemo (11) – 1 went on to receive chemo O

19. SACT 30 Day post-chemotherapy mortality
Chemotherapy intelligence unit
National cancer intelligence Network
Systemic anti cancer therapy chemotherapy database
NHS England and Public health England
CIU of NCIN collecting NHS cancer chemo data since April 2012 (SACT)
Mandatory for all NHS trusts April 2014
For NHSE and PHE - CIU produce 30-day breast and lung mortality data
Short-term (30-day) mortality metric good clinical practice
Data published/ outliers identified
Publication January 2016

20. SACT 30 Day post-chemotherapy mortality
Lung Palliative
1 death/ 1 patient [100% 30 day death rate]

21. SACT 30 Day post-chemotherapy mortality

22. SACT 30 Day post-chemotherapy mortality
Lung Palliative
1 death/ 1 patient [100% 30 day death rate]
15 death/ 205 patients [7.3% 30 day death rate]

23. Discussion
Could oncology see pts sooner to avoid delays in commencing definitive treatment
Combined lung clinic
Can we more accurately determine PS documented by MDT?
Audit highlighted the importance of accurate prospective data collection
Understand patterns of service provision
Ultimately improve patient care
The CIU will provide reports via this site, tailored to the requirements of trusts, commissioners, patients and other groups. These will provide a powerful new tool to understand patterns of service provision and support rational decision making to improve patient care. The programme provides a clear picture of patterns of chemotherapy being given across England by hospital and geographical area. Data collected within the SACT programme will show the immediate outcome of chemotherapy treatment and when linked to other data sources, can provide a complete picture of the management of cancer.

24. Thank you for listening
Any questions?