1. 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

2. 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.

3. 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

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

5. Participation by strategic clinical network

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

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

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

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

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

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

12. Treatment centres responses
Thoracic surgery (n=16)
Thoracic surgeons
2.25 ( )
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

13. 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

14. 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

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

16. 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