Author Archive

The route back to our 25 by 25 ambition

By Professor Robert Rintoul, chair of the UKLCC’s clinical advisory group, and Professor of Thoracic Oncology, University of Cambridge.

Prior to the pandemic, real progress was being made in raising five-year lung cancer survival rates in the UK. However, COVID-19 has had a devastating impact on early diagnosis of lung cancer and has put the UKLCC’s target of driving up the five-year UK survival to 25 percent by 2025 (25 by 25) in jeopardy.

Recent estimates reveal that delays in diagnosis caused by COVID-19 lockdowns will result in a drop of up to 5% in five-year survival in England – from the latest figure of 17.6% (patients diagnosed 2014 to 2018) – to around 13% for those diagnosed during the pandemic.

Indeed, lung cancer patients have been disproportionately affected by the pandemic. Government guidance to stay at home with a cough, reluctance to engage with healthcare services during lockdown, and pressures on already over-burdened health services, have inevitably resulted in a fall in referrals and increase in late-stage presentations of the disease.

While this backwards step is one of the saddening legacies of the pandemic, as a lung cancer community we must rally together and focus on making improvements going forwards.  It is simply not ambitious enough to be trying to get back to pre-pandemic outcomes, we must be looking to improve outcomes to the best in Europe, and in the world. 

Urgent measures must be put in place to continue the trend of improved five-year survival achieved prior to the pandemic.  One of the most critical things that we must do to achieve this is to move from early diagnosis to earliest diagnosis and shift the needle in long term survival for lung cancer patients.  England is already delivering a world leading pilot programme of lung health checks.  As a group of leading lung cancer experts, we believe that the roll-out of a full lung cancer screening programme across all four nations would do more to improve lung cancer survival than any other single intervention. Twice year public awareness campaigns on signs and symptoms of lung cancer – both nationally and locally – linked to a dedicated patient helpline – will help increase access to support and diagnosis. We urge the four UK governments to move quickly with implementation. 

We also know that when patients have a diagnosis of lung cancer, there are unwarranted variations both between the nations and locally across the four countries.  If the Government’s levelling up agenda was applied to lung cancer, then we would be seeing many more patients accessing potentially curative treatments – which would transform survival. 

We also know that we need to look after and build the cancer workforce better.  We need to train and retain a workforce which is currently in crisis, because without the talented and dedicated people who work across the entire lung cancer pathway, we simply won’t be able to support lung cancer patients in the way that they deserve.

This report provides a blueprint for politicians and policymakers setting out the most important areas of focus to improve lung cancer outcomes.  This is focused on solutions which the clinical community believe will have the biggest impact on outcomes.  We need to act collectively and urgently to rebuild and recover from the consequences of the pandemic on lung cancer and get back on track to deliver a step change in lung cancer outcomes.

Together, we can fix UK lung cancer. To read our full report visit: www.uklcc.org.uk/our-reports/

EXPERTS FEAR THOUSANDS OF ADDITIONAL UK LUNG CANCER DEATHS DUE TO PANDEMIC

SURVIVAL IMPROVEMENTS IN ‘JEOPARDY’ UNLESS URGENT ACTION TAKEN SAYS NEW REPORT

Hard-won gains in improving lung cancer outcomes are now in ‘jeopardy’ with ‘thousands of additional lung cancer deaths’ feared as a result of the COVID-19 pandemic, says a report published today (25th November 2021) by the UK Lung Cancer Coalition (UKLCC).

“Prior to the pandemic, real progress was being made in raising five-year survival rates,” says Professor Robert Rintoul, chair of the UKLCC’s clinical advisory group, and Professor of Thoracic Oncology, University of Cambridge. “But COVID-19 has had a devastating impact on early diagnosis of lung cancer and has compromised our target of driving up five-year UK survival to 25 percent by 2025.”

Estimates reveal that delays in diagnosis caused by COVID-19 lockdowns may result in a drop of up to 5.3% in five-year survival in England1 – from 17.6% (for patients diagnosed 2014 to 2018) pre-pandemic2 – to around 12.3% for those diagnosed during the pandemic. This could equate to over two and a half thousand additional deaths in the UK.3

“Lung cancer patients have been disproportionately affected by the pandemic. Government guidance to stay at home with a cough, reluctance to engage with healthcare services during lockdown, and pressures on already over-burdened health services, have inevitably resulted in a fall in referrals and increase in late-stage presentations of the disease. We need to take urgent action to get back on track,” adds Professor Rintoul.

The UKLCC’s ’Route back to 25 by 25’ report, compiled by lung cancer clinicians and nurse specialists from across the UK, is demanding a ‘levelling up’ in lung cancer, with a fully funded, screening programme across all four UK nations. In addition, it is calling for twice-yearly national and regional public awareness campaigns, linked to a dedicated lung cancer helpline, to ensure easy access to support and diagnosis for patients, without placing an additional burden on primary care.

Lung cancer has consistently been the UK’s biggest cancer killer with 35,100 people dying each year. It accounts for more than a fifth of all UK cancer deaths (21%)4 – and lung cancer in never smokers is the eighth most common cause of cancer-related death in the UK.5 However, lung cancer can be cured if diagnosed early enough. The UK has one of the worst five-year lung cancer survival rates in Europe.6

Other key recommendations in the report, include:

“It has been heart-breaking to see the hard work and achievements of those involved in lung cancer care impacted so enormously by COVID-19. We must rally together and ensure that the pre-pandemic progress in lung cancer outcomes was not in vain. We can fix UK lung cancer,” says Martin Grange, Chair of the UKLCC.

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About the report

Entitled ‘The Route back to 25 to 25’, the report is based on the outcomes of a meeting of the UKLCC’s Clinical Advisory Group in June 2021 plus follow-up interviews with clinical leaders in each of the four UK nations. Unlike our previous report, COVID-19 Matters (published October 2020), it looks beyond the impact of the first wave of the pandemic and provides a series of recommendations which offer a ‘route-back’ to delivering on our original 2016 survival ambition: to re-double five-year lung cancer survival to 25 percent by 2025. To view our reports, visit: www.uklcc.org.uk/our-reports

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. It is now looking to redouble five-year survival to 25 percent 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. https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(20)30388-0.pdf
  2. https://www.gov.uk/government/statistics/cancer-survival-in-england-for-patients-diagnosed-between-2014-and-2018-and-followed-up-until-2019
  3. Accessed on 21 November 2021 and available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/incidence#heading-Zero
  4. on 21 November 2021 Nov 2021 and available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality
  5. https://journals.sagepub.com/doi/full/10.1177/0141076819843654
  6. https://ihe.se/wp-content/uploads/2020/10/IHE-Report-2019_7_.pdf

VIRTUAL APPOINTMENTS NOT THE TIME TO DELIVER BAD NEWS SAY LUNG CANCER PATIENTS AND HEALTHCARE PROFESSIONALS

Lung cancer patients are more likely to worry about receiving bad news if offered a virtual (video or telephone) appointment, says a new report published today1 (27th November 2020) – supported by the Roy Castle Lung Cancer Foundation, British Thoracic Oncology Group, Lung Cancer Nursing UK and UK Lung Cancer Coalition.

The report, which examines patients and health professionals’ perspectives on the increased use of virtual consultations in response to COVID-19, reveals around half of lung cancer patients would be ‘worried’ or ‘extremely worried’ if offered a video or telephone appointment (50 and 41 percent respectively) during the pandemic.  Nearly all patients (95 per cent), who were surveyed as part of the report, stated that meeting face-to-face was by far the best method of communicating their diagnosis – as well as having an initial consultation.

“Every patient worries about getting bad news and for healthcare professionals breaking bad news is one of the hardest aspects of their job. Virtual consultations are simply not appropriate in this situation, particularly as lung cancer patients tend to present at the late stage of their disease. Being told you have lung cancer, or your disease has become incurable is life-changing news – a phone or video consultation is not the right way to find out,” says Lorraine Dallas, Director of Information, Prevention and Support, Roy Castle Lung Cancer Foundation.

Since the beginning of the pandemic, the report concludes that most consultations have moved to virtual, with 92 per cent of patients having at least one conversation with their nurse or hospital physician virtually.  Yet, the majority of virtual appointments have been by telephone (90 per cent) – with only 13% of lung cancer patients receiving video consultations.

“The fact that video is so seldom used to deliver virtual consultations may surprise some people – but not those working within NHS hospitals,” says Professor Sanjay Popat, Consultant Thoracic Medical Oncologist, Royal Marsden NHS Foundation Trust, and Steering Committee Chair, the British Thoracic Oncology Group.

The report states nearly seven out of ten (69 per cent) patients were not given a choice between telephone or video – and more than three quarters (76 per cent) of healthcare professionals surveyed said they had not received any training or guidance for delivering virtual appointments. Almost two-thirds (65 per cent) of health professionals said lack of computer equipment to hold video consultations was a regular problem.

“This survey exposes some of the huge infrastructure changes that need to happen to make video consultations workable long-term in both secondary and tertiary lung cancer care settings,” adds Professor Popat.

However, of those patient respondents who had received a video consultation, many saw clear advantages with nearly three-quarters (71 per cent) citing it was more convenient e.g. allowing them to avoid travelling into hospital, and could see the untapped potential, especially for routine appointments.

While 75 per cent of healthcare professionals agreed that video consultations were more convenient for patients – conversely, only 30 per cent said they were more convenient for them. Disadvantages include the inability to share visual material such as scans with their patients; difficulties in assessing a patient’s physical condition virtually; and the lack of quiet, private, meeting spaces in a hospital to be able to deliver video consultations.  

As a result, the report highlights a series of key considerations to help improve the use of virtual consultations, and develop best practice tools – not only for lung cancer, but other cancer services and the wider NHS:

  • urther research is needed into the use of virtual consultations involving patients who do not have computer access, or feel confident in using them, to ensure health inequalities are not being exacerbated

“When the COVID-19 pandemic hit, healthcare professionals across the NHS went to extraordinary lengths to keep patients as safe as possible,” says Martin Grange, Chair of the UK Lung Cancer Coalition. “In the right circumstances, and with the necessary infrastructure and support for health professionals, virtual consultations can offer patients quicker access to the expertise that is required in delivering some aspects of their care.”

To download a copy of the report, visit: www.roycastle.org  www.uklcc.org.uk  www.btog.org   www.lcnuk.org

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About the report:

The report is the culmination of two, separate, online surveys –  a patient questionnaire supported and  disseminated by the Roy Castle Lung Cancer Foundation (RCLCF) – and a healthcare professional survey, overseen and distributed by the British Thoracic Oncology Group (BTOG), Lung Cancer Nursing UK LCNUK and UK Lung Cancer Coalition (UKLCC). Both surveys, and the report, were funded by MSD. The four, survey partner organisations were supported by healthcare policy consultants Incisive Health and market research consultancy, Healthcare Research Worldwide (HRW).

The online surveys were carried out between 29 September to 19 October 2020 and over 200 individuals participated: 105 patient and carers and 80 health care professionals (the majority working in secondary and tertiary care).

Over a quarter (26%) of patients who participated in the survey were diagnosed just prior to lockdown and during the first three months of the pandemic. Learnings from the surveys are intended to help create practical tools and best practice guidance which can be used as a blueprint for virtual working not only within the lung cancer community but also by other medical specialities.

About lung cancer

Lung cancer is the UK’s biggest cancer killer with 35,300 deaths each year (97 people every day or one person every 15 minutes) which is more than deaths from bowel cancer, prostate cancer, and liver cancer, combined.4.5Half of all people diagnosed with lung cancer die within six months.Lung cancer accounts for more than a fifth of all UK cancer deaths (21%) and in never smokers is the 8th most common cause of cancer-related death in the UK.However, lung cancer can be cured if diagnosed early enough.

Roy Castle Lung Cancer Foundation

Roy Castle Lung Cancer Foundation is the only UK lung cancer charity dedicated to helping everyone affected by the disease – from diagnosis, through treatment, living with the disease and end of life care. Since it was established in 1990, it has funded millions of pounds of essential lung cancer research. Much of its focus is on raising awareness of lung cancer and challenging the misconceptions that exist around the disease. For more information, visit https://www.roycastle.org

British Thoracic Oncology Group

The British Thoracic Oncology Group’s (BTOG’s) mission is to support and educate thoracic oncology healthcare professionals, creating a professional community to exchange ideas, information, and innovation and to foster the development of research. The overall aim is to represent the needs of people with thoracic malignancies in the UK and ensure they have equitable access to optimal care.  BTOG’s vision is to contribute to achieving survival rates equal to the best in the world. For more information, visit https://www.btog.org/

Lung Cancer Nursing UK

Lung Cancer Nursing UK (formerly the National Lung Cancer Forum for Nurses) was established in 1998 with the primary objective of providing networking and support for lung cancer specialist nurses. More latterly it has focused on activities such as education and best practice sharing as well as improving understanding of the expertise and professionalism of specialist nurses among the wider clinical community and policy makers. For more information, visit https://www.lcnuk.org

UK Lung Cancer Coalition

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 the disease. For more information, visit www.uklcc.org.uk

MSD

MSD is a trade name of Merck & Co., Inc., with headquarters in Kenilworth, N.J., U.S.A. We demonstrate our commitment to patients and population health by increasing access to health care through far-reaching policies, programmes and partnerships. Today, MSD continues to be at the forefront of research to prevent and treat diseases that threaten people and animals – including cancer, infectious diseases such as HIV and Ebola, and emerging animal diseases – as we aspire to be the premier research-intensive biopharmaceutical company in the world. For more information, visit www.msd-uk.com

References

  1. Virtual consultations in the lung cancer pathway – what works for patients and healthcare professionals? Report supported by Roy Castle Lung Cancer Foundation, British Thoracic Oncology Group, Lung Cancer Nursing UK and the UK Lung Cancer Coalition. November 2020. Accessed from 26th November 2020 here: www.roycastle.org  www.uklcc.org.uk  www.btog.org   www.lcnuk.org
  2. NHS England and NHS Improvement, Clinical guide for the management of remote consultations and remote working in secondary care during the coronavirus pandemic, 27 March 2020. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0044-Specialty-Guide-Virtual-Working-and-Coronavirus-27-March-20.pdf
  3. British Medical Association (2020). COVID-19: video consultations and homeworking. Available at: https://www.bma.org.uk/advice-and-support/covid-19/adapting-to-covid/covid-19-video-consultations-and-homeworking
  4. , accessed Aug 2020 and available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality
  5. https://www.cancerresearchuk.org/health-professional/cancer-statistics/mortality/common-cancers-compared#heading-Zero
  6. . Peake M et al. Accessed August 2020 at: https://journals.sagepub.com/doi/full/10.1177/0141076819843654

Virtual consultations in the lung cancer pathway – what works for patients and healthcare professionals?

When the COVID-19 pandemic hit, healthcare professionals across the NHS went to extraordinary lengths to keep patients as safe as possible. This was especially important in lung cancer, where patients are at particular risk of complications of coronavirus due to their underlying condition and the immunosuppression associated with many treatments.

The move from in-person to ‘virtual’ consultations was essential, but – until now – we have been unsure how this shift during the first wave of the COVID-19 pandemic has affected both people living with lung cancer and the hospital clinical teams looking after them. This is especially relevant because virtual consultations have been suggested to have the potential to speed up the diagnostic treatment pathways.

The findings of a new report endorsed by the Roy Castle Lung Cancer Foundation, UK Lung Cancer Coalition, Lung Cancer Nursing UK and the British Thoracic Oncology Group – and based on surveys of lung cancer patients, their carers’ and the clinical community – are an important insight into the use of virtual consultations in lung cancer care.

Among the findings, the surveys revealed that ‘virtual’ really meant ‘telephone’ for most patient appointments – with very few conducted via video. Many health professionals felt video consultations were not convenient for them, for example, they were unable to share scans with patients, they had not received any relevant training or were unable to access to the right equipment. In addition, as the first wave subsided, many secondary care lung cancer services quickly moved back to face to face consultations, demonstrating the need and importance of human interaction.

The report considers that further research is needed into the use of virtual consultations involving patients who do not have computer access, or feel confident in using them – and healthcare professionals should be provided with training to support both communication and technical aspects involved with delivering of virtual consultations. In addition, given the often, late stage, diagnosis and urgency that comes with it, there is a need for lung cancer-specific best practice guidelines which go beyond current general clinical guidance for the management of remote consultations.

It is likely that virtual consultations are here to stay – and will increase as a means to deliver care in the future NHS as a whole.  The report states that, in the right circumstances, and with the necessary infrastructure and support for healthcare professionals, video and telephone consultations could offer lung cancer patients quicker access to the expertise that is required in delivering some aspects of their care. However, virtual appointments will complement but never replace face to face appointments.

Martin Grange – Chair, UKLCC

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.”

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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.

Contact

UKLCC Secretariat: Red Hot Irons Ltd, Miria House, 1683b, High St, Knowle, Solihull, B93 0LL

Tel: 01675 477605
Email: info@uklcc.org.uk
Media enquiries only: Call 07778 304233

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