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75 PER CENT DROP IN URGENT LUNG CANCER REFERRALS DURING LOCKDOWN SAY EXPERTS

Third of lung cancer patients have already died since start of pandemic

The number of people urgently referred to a lung cancer specialist dropped by 75 percent during the first wave of the Covid-19 pandemic, says a new report published today (21st October 2020) by the UK Lung Cancer Coalition (UKLCC).1

“Fear of engaging with health services, halting the national programme of lung cancer screening pilots, and restricted access to diagnostic tests have all contributed to a drop in urgent two-week wait GP referrals in England,” says Professor Mick Peake OBE, chair of the UKLCC’s Clinical Advisory Group.

According to NHS England, there were 62,461 two-week wait lung cancer referrals in 2019-20.2

“Government guidance to stay at home with a cough, a key symptom of lung cancer, has also caused further confusion,” says Professor Peake.

The report states that the reduction in referrals will lead to a backlog in outpatient appointments, surge in late-stage presentations and potentially hundreds of additional lung cancer deaths – reversing the progress achieved in lung cancer survival over the last 10 to 15 years.Between 2005 and 2015, five-year lung cancer survival almost doubled in England from 9 per cent to 16 per cent.3

Other key findings from the report, Covid-19 Matters (compiled from a meeting and interviews with 45 of the UK’s leading lung cancer clinicians and key patient groups) include:

  • It is estimated that at least one third of lung cancer patients have already died since the beginning of the pandemic – some deaths may have been labelled as Covid-19
  • During first wave of pandemic, the risk of a patient dying after lung cancer surgery because they contracted Covid-19 around the time of surgery, increased from around 2per cent4,5 to up to 40-50 per cent1,6

Other key findings from the report, Covid-19 Matters (compiled from a meeting and interviews with 45 of the UK’s leading lung cancer clinicians and key patient groups) include:

  • It is estimated that at least one third of lung cancer patients have already died since the beginning of the pandemic – some deaths may have been labelled as Covid-19
  • During first wave of pandemic, the risk of a patient dying after lung cancer surgery because they contracted Covid-19 around the time of surgery, increased from around 2per cent4,5 to up to 40-50 per cent1,6
  • Over half (55%) of lung cancer nurse specialist nurses or their team member were re-deployed or unable to work as a result of Covid-191,7

As a result, the report makes a series of key recommendations, which include calling on Government and the new National Institute for Health Protection to:

  • Rapidly launch a ‘Be Clear on Lung Cancer and Covid-19’ campaign to increase awareness of lung cancer symptoms and the public’s confidence in engaging with healthcare services early
  • Quickly resume those local lung cancer screening pilot programmes that were already operational
  • Urgently review isolation and visiting restrictions in hospital and palliative care settings to enable critically ill patients to see their families during the final phase of their lives
  • Provide necessary funding to establish Community Diagnostic Hubs to reduce the risk of COVID-19 transmission and accelerate diagnostic turnaround time for lung cancer patients.1

Provide necessary funding to establish Community Diagnostic Hubs to reduce the risk of COVID-19 transmission and accelerate diagnostic turnaround time for lung cancer patients.1

Lung cancer is the UK’s biggest cancer killer with 35,300 people dying each year.It accounts for more than a fifth of all UK cancer deaths (21%)8 – and lung cancer in never smokers is the 8th most common cause of cancer-related death in the UK.9 However, lung cancer can be cured if diagnosed early enough.

“The survival and quality of life of lung cancer patients will have been seriously and adversely affected as a result of Covid-19,” says Mr Martin Grange, chair of the UKLCC.  “Therefore, we urge everyone in the lung cancer community, be they clinicians, nurses, managers or policy makers to work together to help us recover the previous momentum in improving quality of care for people with lung cancer and continue to save lives.”

-ends-

About the report

Entitled Covid-19 Matters, a review of the impact of COVID-19 on the lung cancer pathway and opportunities for innovation emerging from the health system response to the pandemic, the report based on the outputs of the UKLCC’s Clinical Advisory Group on 26th June 2020 plus a series of interviews with lung cancer experts including patient groups. It was also informed by comprehensive desk research and a literature review of key statements and publications, including written stakeholder submissions to the Health Select Committee inquiry on Delivering Core NHS and Care Services during the Pandemic and Beyond.

About urgent two-week wait referrals

In England, GPs are requested to send patients for an urgent chest x-ray within two-weeks if they show suspected lung cancer symptoms. They should refer to a specialist if the x-ray shows anything abnormal.

About the UKLCC

The UK Lung Cancer Coalition (UKLCC) is the UK’s largest multi-interest group in lung cancer. It was set up in 2005 with the founding ambition to tackle poor lung cancer survival outcomes and, specifically, to double five-year survival by 2015, which was effectively achieved. The UKLCC has published numerous milestone reports including ‘25 by 25 – a ten-year strategy to improve lung cancer survival rates’ – calling for a re-doubling of five-year lung cancer survival rates to 25 per cent by 2025. The UKLCC’s membership includes leading lung cancer experts, senior NHS professionals, charities and healthcare companies with an interest in fighting lung cancer. For more information about our work and members, visit:  www.uklcc.org.uk

References:

  1. UK Lung Cancer Coalition.  October 2020. Accessible from 21st October here: www.uklcc.org.uk/our-reports
  2. NHS England Waiting Times for Suspected and Diagnosed Cancer Patients 2019-20 Annual Report. Accessed October 2020 here:   https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/07/Cancer-Waiting-Times-Annual-Report-201920-Final.pdf
  3. Walters S, Benitez-Majano S, Muller P, et al., ‘Is England closing the international gap in cancer survival?’ Br J Cancer, 4 S 2016, doi: 10.1038/bjc.2015.265 Accessed October 2020 at: https://www.nature.com/articles/bjc2015265
  4. The Society for Cardiothoracic Surgery in Great Britain & Ireland. Accessed here:  https://scts.org/wp-content/uploads/2019/03/Thoracic-Blue-Book-2018-FINAL.pdf
  5. Glasbey et al.  J Clin Oncol. October 2020. Accessed at:  https://ascopubs.org/doi/10.1200/JCO.20.01933
  6. Mortality and Pulmonary Complications in patients undergoing surgery with peri-operative SARS-CoV-2 Infection– An international cohort study. The Lancet 2020: 396;27-38. COVID SURG Collaboration Accessed here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext
  7. The impact of COVID-19 on lung cancer care: views from lung cancer specialist nurses. Lung Cancer Nursing UK. October 2020. Accessed here: https://www.lcnuk.org/news/impact-covid-19-lung-cancer-care-views-lung-cancer-specialist-nurses
  8. Figures from Cancer Research UK, accessed Aug 2020 and available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality
  9. Peake M et al. Accessed August 2020 at: https://journals.sagepub.com/doi/full/10.1177/0141076819843654

Media enquiries, please contact:

Lynsey Conway

UKLCC Communications Consultant

07778 304233

email@lynseyconway.co.uk

Assessing the impact of COVID-19 on lung cancer services

Whilst the overall outcomes for lung cancer across the world remain poor compared to many other cancers, and survival of patients in the UK has consistently been shown to be worse than in many other countries, the care and outcomes for lung cancer patients in the UK have been steadily improving over the last 15-20 years. The UKLCC has been consistently pushing for a range of efforts to achieve a 5-year survival rate of 25% by 2025[i] – a target that the expert community which it represents felt is entirely achievable.

Felt, that is, before the catastrophe that is the Covid-19 pandemic. Covid-19 has clearly affected every aspect of our lives and our health care systems, so to that extent lung cancer is just one amongst many issues to be faced as a result.

The UKLCC’s new report Covid-19 Matters – a review of the impact of COVID-19 on the lung cancer pathway and opportunities for innovation emerging from the health system response to the pandemic accessible here www.uklcc.org.uk/ is based on feedback from a meeting of the UKLCC’s Clinical Advisory Group in June 2020, follow up interviews with a wide range of experts, plus desk-top research. 

The report not only highlights the adverse impact of the pandemic on lung cancer care and outcomes, but also positive changes in practice which we can learn from, adopt and adapt across the UK.  In addition, it makes a series of hard-hitting recommendations aimed at NHS bodies, national governments, and the Lung Cancer Clinical Expert Group, to help improve UK lung cancer care going forward.

These are as follows:  

We ask that you share this report with your colleagues, networks, managers and policy makers so they reflect on the issues and actions outlined in this report and do all they can to ensure that we recover the momentum that had been building in the lung cancer community.

  1. Where they are operational, lung cancer screening programmes should be supported to resume at the earliest opportunity.
  2. Isolation and visiting restrictions in hospital and palliative care settings need to be reviewed urgently to enable critically ill patients to see their families in the final phase of their lives.
  3. In England, Integrated Care Systems (ICSs) should be provided with the necessary funding to establish Community Diagnostic Hubs to reduce the risk of COVID-19 transmission and accelerate diagnostic turnaround time for lung cancer patients.
  4. Every NHS Trust should be provided with the necessary IT infrastructure to enable specialists to contribute effectively to virtual meetings and ensure a high-quality discussion. 
  5. The NHS should work with the relevant national Health Technology Assessment bodies to assess the impact that the changes in treatment and delivery schedule have had on lung cancer patients to harness the potential improvements to patient survival outcomes as well as to their quality of life.
  6. ‘Be Clear on Lung Cancer and COVID-19’ campaigns should be launched to increase awareness of potential lung cancer symptoms and increase the public’s confidence across the UK in engaging with the healthcare system early.
  7. Within its 2020 Spending Review, the Government should recognise the level of revenue and capital funding required to implement the recommendations of the review of diagnostic and workforce capacity of cancer services across the country, led by Professor Sir Mike Richards.
  8. The lung cancer clinical community should work together to promote the coherent adoption and implementation of national optimal lung cancer guidelines across the UK to ensure people affected by lung cancer receive optimal care no matter where they live
  9. To unlock the opportunities offered by the adoption of the remote consultations, research should be undertaken across the lung cancer patient and clinical community to develop best practice guidance to support lung cancer services in optimising the use of remote consultations.
  10. The Lung Cancer Clinical Expert Group should develop the evidence base for NICE to consider for the adoption of straight to CT GP referral and communicate the findings to support pathway change in all four nations.
  11. The Lung Cancer Clinical Expert Group should work with the lung cancer clinical community across the UK to review the evidence base for the routine commissioning of liquid biopsy for patients with advanced disease with a high probability of an abnormal gene in their tumour.

Thank you!

Martin Grange – Chair, UK Lung Cancer Coalition

Professor Mick Peake OBE – outgoing Chair, Clinical Advisory Group

Dr Robert Rintoul – incoming Chair, Clinical Advisory Group


[i] UKLCC, The UKLCC, ten-year strategy towards achieving 25% lung cancer survival rate by 2025, https://www.uklcc.org.uk/wp-content/uploads/2017/11/UKLCC-25-by-25-FINAL.pdf

Brave new world: your views on virtual consultations and lung cancer needed

Over the last six months the world has changed beyond recognition as people and organisations   have adapted to lockdowns, social distancing and working remotely. The NHS has been remarkably adept at responding to the pandemic by changing many ways of working overnight and many of these initiatives have come out of local staff and clinical leaders.

With overlapping symptoms making lung cancer particularly complicated, clinical teams have worked especially hard to adapt existing practice and procedures to maintain a safe diagnostic and treatment service and support their patients during these very, difficult times. And – with increasing pressure, we think it is essential we take time to capture this experience and map where in the pathway these virtual consultations have had the biggest advantages or disadvantages. We must also consider the new skills and effort you have needed to develop to make the system work.  

UKLCC is working with BTOG and LCNUK to conduct a survey (collaborating with and funded by MSD) to gather information on how health professionals are using virtual consultations and what nurses and primary and secondary care clinicians think about them.  We are also very interested in assessing the strengths and weakness of virtual MDTs.

In parallel, the Roy Castle Lung Cancer Foundation is running a patient survey on virtual consultations.  Our intention is to publish the findings of both surveys in one single report later this year – with recommendations and strategies to help shape national guidance and develop support tools for health professionals and their patients going forward.

Please share your experience with us by completing this survey here

It is really important to map experience at all stages of the patient journey so please share with your MDT and primary care colleagues and encourage them to share their experience and skill as well.

The survey deadline is w/c 19th October.   

Thank you for what you have done.

Martin Grange – Chair, UK Lung Cancer Coalition

Professor Mick Peake awarded OBE

We are delighted and proud to announce that Professor Mick Peake has been awarded an OBE for his services to medicine in the Queen’s Birthday Honours list.

Without a doubt, lung cancer services in the UK would not be where they are today without Mick. He has made an outstanding contribution to improving outcomes for lung cancer patients and worked tirelessly throughout his long career championing early diagnosis and driving the issue of lung cancer up the political agenda.

Mick has been involved in the development of national policy for lung cancer and cancer intelligence in many roles including Clinical Lead for the National Cancer Intelligence Network (NCIN) and for the National Lung Cancer Audit Programme (NLCA), which he set up amidst a great deal of scepticism. He was also National Lead Clinician for Lung Cancer in NHS Improvement where he was also the secondary care lead for the National Awareness and Early Diagnosis Initiative (NAEDI).

Mick currently holds the roles of Clinical Director, Centre for Cancer Outcomes, North Central and East London Cancer Alliance; Honorary Clinical Lead, National Cancer Registration and Analysis Service (NCRAS); Specialist Clinical Advisor, Cancer Research UK; and he is also Emeritus Consultant and Honorary Professor of Respiratory Medicine, at the University of Leicester, where he was based for much of his career.

Mick launched the UK Lung Cancer Coalition (UKLCC) in Westminster in 2005. It has been a major force in lobbying NHS Trusts to submit data for the NLCA, driving up best-practice and standards. The UKLCC to date has published more than ten, well-respected, national reports.

He also had a significant hand in starting the National Lung Cancer Forum for Nurses (now Lung Cancer Nursing UK), and the British Thoracic Oncology Group (BTOG).

Mick has been widely published and been in receipt of many lifetime achievement and service awards.

Everyone who knows Mick will know him as a modest, self-less and lovely man who deserves this wonderful reward for his achievements. As he steps down from his role as chair of the UKLCC Clinical Advisory Group at the end of this year, we want to thank him for everything he has done, his vision and ongoing dedication.

We will miss him, but we know Mick will continue to support the UKLCC and be involved in championing the needs of lung cancer patients.

Martin Grange – Chair, UK Lung Cancer Coalition

Dr Robert Rintoul – Reader in Thoracic Oncology, University of Cambridge and Honorary Consultant in Respiratory Medicine, Royal Papworth Hospital; incoming Chair UKLCC Clinical Advisory Group

Why we need the National Lung Cancer Audit to continue

Understanding what is happening in clinical practice and how this is affecting patient outcomes depends on having first-class data collection and reporting.  Consequently, the UKLCC welcomed the recent news that the Royal College of Physician’s contract for the National Lung Cancer Audit (NLCA) has been extended to October 2021.

Since 2004, when it was established, the NLCA has played an instrumental role in helping the NHS make steady progress in improving the quality of care and outcomes for lung cancer patients. Prior to its introduction, lung cancer care in the UK was fragmented and five-year lung cancer survival in the 1990s averaged around the five percent mark.  The UKLCC was a key protagonist in lobbying NHS Trusts to participate in the Audit – which now represents data from more than 170 individual organisations. 

As a result, the NLCA has continued to provide valuable insights into regional and national service performance and been used to set standards of care – for example, 90% of patients should be assessed by a lung cancer nurse specialist.1 These standards are designed to make the treatment and outcomes  in England reach the levels seen in a number of other countries with  comparable health systems.  They also encourage those organisations with the most divergent results to look closely at them and formulate action plans to improve performance.

However, whilst outcomes have improved over the past decade or so, the latest findings from the NLCA have identified that only just over a third (37%) of lung cancer patients will survive for one-year, which is unchanged from the previous year.In addition, the latest figures from the Office for National Statistics revealed that just 14% of men and 19% of women in England will still be alive after five years from diagnosis.2 Although that is a great improvement from the level back in the 1990s, UK lung cancer survival rates still lag behind certain Westernised countries.3 There are also still wide variations in treatment and survival rates between different parts of the UK.1

It is therefore imperative we do not become complacent and whilst we very much welcome news of the recent contract extension, we need to ensure the long-term future of the NLCA so we can continue to drive further improvement in lung cancer care and outcomes of all MDTs – and help to reach the UKLCC’s ambition of doubling five-year survival rates to 25% by 2025.

Despite the current toll of the coronavirus pandemic, we hope that Trusts continue to upload and share their lung cancer data. Lung cancer patients deserve it.   

Professor Mick Peake, Clinical Lead UKLCC Clinical Advisory Group; Clinical Director, Centre for Cancer Outcomes, North Central and East London Cancer Alliance; Emeritus Consultant and Honorary Professor of Respiratory Medicine, University of Leicester; Honorary Clinical Lead, NCRAS; Specialist Clinical Advisor, Cancer Research UK

Lung cancer and mesothelioma service guidance during the COVID-19 pandemic

Developed by the Lung Cancer Clinical Expert Group (25.3.20)

At the time of writing, the COVID-19 pandemic is predicted to place unprecedented pressure on the NHS. The trend in the number of deaths reported with COVID-19 infection matches those reported from Italy but lag by 14 days.  We therefore anticipate that services and resources will be redirected and adherence to the currently commissioned National Optimal Lung Cancer Pathway will be impossible. It is important that measures are taken to preserve cancer services throughout the pandemic, but in a manner that balances first, the risks to the cancer patient contracting COVID-19 during investigations and treatments and second, the care providers’ capacity. The purpose of this guidance is to provide assistance to cancer teams in this regard and in particular to show how pathways can be adjusted to reduce the use of resources and the risk of infection. The guidance also suggests how to prioritise patients most likely to be harmed by delays.  The guidance takes further the NHS Clinical Guide for the Management of Patients During the Coronavirus Pandemic (17 March 2020 V1). The guidance also draws on that being produced by the relevant Royal Colleges and specialist societies. This guidance does not cover the Targeted Lung Health Checks and CT screening, currently suspended and awaiting further advice from the National Cancer Programme Team.

This is a rapidly evolving situation and this guidance may need to be updated regularly.

This guidance cannot cover all clinical scenarios. Individual clinicians, trusts and MDTs will always make the final decisions on the most appropriate action for individual patients and their local services.

  1. Diagnostics and staging

These recommendations are designed to minimise the need for hospital attendance and to minimise the duration of any hospital attendances whilst maintaining an appropriate and effective diagnostic and staging pathway.

  • Primary Care clinicians should consider alternative strategies to immediate referral for lower risk patients, supported by risk-prediction tools where available.
  • The normal triage process should be employed that includes correspondence with patients; those without cancer, or at very low risk, should not be invited for an appointment at the hospital. Consider telephone consultation and repeat scans for indeterminate findings scheduled after the anticipated reduction in COVID-19 infections.
  • Where appropriate, telephone consultations should be used in place of scheduled visits to the hospital, e.g. for results and planning of subsequent tests.
  • Ensure that all investigations are necessary to plan treatment; avoid where no treatment is likely.
  • Consider whether delaying diagnostic and staging investigations will  significantly compromise outcomes before proceeding.
  • Follow the guidance for bronchoscopy available on the BTS website / NHSE, (figure 1). In addition:
    • Avoid bronchoscopy and EBUS in patients with a low risk of cancer
    • Consider interval imaging rather than sampling
    • When indicated, use PET-CT prior to any staging EBUS and to identify alternative biopsy target.
    • In cases where there is a low risk of mediastinal disease, consider percutaneous lung biopsy or proceeding directly to treatment based on lung cancer probability (including the use of the Herder model)
  • Consider day case mediastinoscopy as an alternative to EBUS
  • Omit contrast enhanced CT brain in clinical stage II lung cancer.
  • Do not perform full lung function testing when the clinician and surgeon are happy with simple spirometry
  • Do not perform functional exercise testing in patients with adequate spirometry or if carried out adequate predicted post-operative lung function (ppo-FEV1 and ppo-DLCO >40%) and performance status 0-1
  • For patients that do require a functional assessment consider alternatives to a shuttle walk test to minimise number of visits to the hospital e.g. stair climb.
  • Consider CT surveillance to measure growth rate rather than staging and treatment in those lesions likely to be indolent or benign, including pure ground-glass nodules and smaller part-solid and solid nodules.
  • Prioritise patients with likely aggressive disease or where a delay would result in the patient becoming unresectable.
  • Consider implementing virtual nodule management avoiding visits to hospital. Consider extending the scheduling follow-up CTs, in low risk patients well outside the peak of the pandemic. Use telephone follow-up and/or correspondence to convey results.
  • In patients with a never/light smoking history and clear radiological suggestion of advanced primary lung cancer, consider plasma test for EGFR mutation instead of biopsy.

Figure 1: Summary of Bronchoscopy Guidelines

  • Treatment

Clinicians should discuss with patients whether the risks of starting anticancer treatment could outweigh the benefits during the covid-19 outbreak. This is particularly true for patients considered for systemic anti-cancer treatment (SACT). In the event of disruption to cancer services, surgery, radiotherapy and SACT will be prioritised for patients most in need, according to the Priority Categorisation set out in the NHS Clinical Guide for the Management of Patients During the Coronavirus Pandemic (17 March 2020 V1)

2.1 Surgery and curative-intent treatment

Thoracic surgery capacity has reduced significantly and is likely to reduce further as theatre space and anaesthetic cover is required for additional ventilators. Patients should be offered treatment according to the accepted standard of care until limitations of services require a progressive reduction in surgery.  Patients most likely to be harmed by a change of treatment to non-surgical or by a delay in surgery should be prioritised.  In addition, radiotherapy services will come under increased pressure so regimes will need adjustment where possible. The MDT needs to discuss this and decide which patients are highest priority. In addition:

2.1.1 Surgery and curative-intent radiotherapy/chemoradiotherapy

  • Consider deferring treatment in lesions likely to be indolent, with follow up CT to confirm growth rate.
  • Prioritise referral and pathway to thoracic surgery for cases of:
    • Symptomatic lung cancer (infection, pain, bleeding, breathlessness)
    • Stage IIb/IIIa lung cancer at most risk of  stage progression / becoming unresectable
  • Plan surgery to minimise length of stay, by using minimal access surgery, day case or day of surgery admission.
  • The benefit of adjuvant chemotherapy may be outweighed by the risk so consider omitting this and stopping existing treatment early at 3 cycles.
  • In higher risk patients, particularly those not fit for a lobectomy, consider direct referral for radiotherapy.
  • Consider treatment without biopsy, as above, using Herder score
  • Suspend trimodality treatment for N2 positive lung cancer.
  • In patients suitable for SABR without nodal disease and tumours <2cm, consider SABR rather than surgery when surgical capacity is reduced.
  • Consider delaying radiotherapy treatment until risk of exposure reduces in patients with stage I-II disease
  • Use hypo-fractionated regimens wherever possible- See RCR emergency paper for protocols.
  • Consider omitting induction component of chemoradiation and limiting to concurrent therapy.
  • Consider temporarily stepping down routine post radical treatment surveillance. An alternative would be nurse led telephone consultations
  • Pre- and post-operative clinical appointments should be remote (via secure video-link to telephone call) whenever possible.  MDT attendance should be remote (video-link ideally) whenever possible

2.2 Systemic anti-cancer therapy

  • Defer face to face consultation with oncologists until complete predictive marker analysis is available.
  • Patients should be counselled about the risks of chemotherapy during the pandemic and risk stratified according to tumour biology urgency of treatment.
    • Defer treatment of indolent disease.
  • Consider restricting SACT to patients of PS 0-1
  • Consider offering GCSF to all patients undergoing cytotoxic chemotherapy.
  • Utilise the least labour (pharmacist and nursing) intensive regimen where possible e.g. platinum/pemetrexed, taxol/carbo or platinum/oral vinorelbine.
  • Use a maximum 4 cycles of cytotoxic chemotherapy per course.
  • Denosumab should be available for self-administration.
    • Omit routine dental review before commencement.
  • Omit maintenance pemetrexed.
  • For patients suitable for first-line immunotherapy, monotherapy is preferred over combination chemo-immunotherapy.
  • Immunotherapy should be offered 4 or 6 weekly to minimise hospital attendances.
  • Third or more line therapy should not to be offered routinely.
  • Imaging whilst on treatment should utilise most pragmatic modality- consider CXR rather than CT or alternate between modalities.

2.3 Palliative radiotherapy

  • Consider offering radiotherapy without a tissue diagnosis if patient unlikely to benefit from systemic therapy.
  • Use hypo-fractionated regimens where possible.
  • Omit PCI and thoracic consolidation for ED-SCLC.

2.4 End of treatment

End of treatment summaries should be completed detailing the variation from standard of care to enable subsequent treatment planning.

2.2: Supportive Care

  • All patients, regardless of stage, should be offered a discussion regarding advance care planning.
  • Enhanced supportive care should be offered to all patients who are stage IIIB/IV.

Dr Matt Evison talks about the award-winning RAPID programme

Lung cancer is the biggest cause of premature death in Greater Manchester. The Multi-Disciplinary Lung Cancer Team, led by Dr Richard Booton at the North West Lung Centre, Wythenshawe Hospital, has therefore spent the last two years dedicated to transforming its lung cancer pathway.

This has involved the complete redesign of the specialist and complex service, to what is now known as the RAPID (Rapid Access to Pulmonary Investigation and Diagnosis) Programme.

Lung cancer diagnosis is complex and requires multiple tests.  The current cancer pathway targets set a maximum waiting time of 62-days from patient referral to treatment – and also sets a target of 85% compliance. Yet, across the UK these targets are not being met.

The core aim of the RAPID Programme was therefore to speed up access to diagnostics, eliminate unnecessary delays, and improve the experience and quality of care for patients with suspected lung cancer – potentially resulting in improved survival.  Our overarching vision was to provide the type of care we would expect for our own families and loved ones.

Central to the RAPID Programme is next-day access to CT imaging (following a referral for suspected lung cancer) – together with same-day hot reporting and clinical review. In patients that do not have lung cancer, this significantly reduces the anxiety of ‘not knowing’. For those in whom lung cancer is suspected we can immediately commence a protocolised investigation pathway consisting of test bundles.  This requires a dedicated patient navigator to coordinate appointments from multiple departments – which involved a great deal of collaborative working and good communication. Daily percutaneous image guided biopsy and daily EBUS services maintain the ‘next day ethos’ of the service. We also undertake a daily virtual board round of all patients on the pathway so that any test results are viewed and timing of MDT discussion and follow-up is appropriately planned. However, setting up the Programme was not without its challenges. The Programme has no control over access to PET scanning and lack of PET provision on-site prevented same-day planning for necessary tests.

The introduction of the RAPID programme has dramatically enhanced the efficiency of the front-end of the lung cancer pathway. Prior to this, of those in the 2-week referral pathway, 0% of patients had their CT scan within four days; 27% had a CT scan within seven days and 74% within 14 days.  Following the implementation of the RAPID Programme, 78% of patients now have their CT scan within four days; 92% within seven days and 99% within 14 days.

In addition, we have also shortened the diagnostic pathway for lung cancer such that 8%, 42%, and 77% of referrals are discussed at MDT – with completed investigations by day 7, 14 and 21, respectively.  This compares with 0%, 8% and 17% prior to the introduction of the RAPID Programme. As a result, 40% of patients received surgery within 14 days of the MDT meeting and we are now working to establish appropriate working practices within thoracic surgery and medical oncology to improve this even further.

With 93% of patients now rating the service delivered through the RAPID Programme as eight out of ten or better, this has confirmed a real improvement in care and an accelerated service for the benefit of patients and their families.

For more information about the RAPID programme and its successes, read our Millimetres Matter report at: https://www.uklcc.org.uk/our-reports/ or contact Dr Matt Evison  matthew.evison@mft.nhs.uk or Dr Richard Booton richard.booton@mft.nhs.uk directly.

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