1 / 26

Improving Lung Cancer Outcomes: Guidelines & Standards

This resource discusses the guidelines and standards for improving lung cancer outcomes, including early diagnosis, access to specialist services, and holistic patient care. It highlights the importance of public awareness and prompt referral for appropriate treatment.

kdamico
Download Presentation

Improving Lung Cancer Outcomes: Guidelines & Standards

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Guidelines and Standards in Lung Cancer David Baldwin Consultant Respiratory Physician NUH Hon Senior Lecturer Nottingham University Clinical lead NICE lung cancer GL Chair NICE QS Topic Expert Group

  2. Matthew Callister, Leeds

  3. Improving outcomes: level of ambition “Our aspiration is that England should achieve cancer outcomes which are comparable with the best in the world” We believe that by 2014/15, 5000 additional lives can be saved each year. It is now for the NHS, working with PHE to deliver this ambition. Note: The “additional 5000 lives” will require England to match the European average. Approximately 10,000 additional lives would be saved if England was to match survival achieved in Sweden (and Australia and Canada)

  4. Adjusted surgery rates 2009

  5. BREAST CANCER 5 YR R.S. OVARIAN CANCER 5 YR R.S. LUNG CANCER 5 YR R.S. COLORECTAL CANCER 5 YR R.S. SWE AUS CAN CAN NOR CAN AUS AUS DEN SWE CAN UK SWE NOR NOR NOR AUS DEN UK DEN UK DEN UK Lancet 2011; 377: 127–38

  6. Possible explanations for ‘poor’ UK cancer survival outcomes • Late diagnosis • lack of public awareness of symptoms • ‘cultural’ attitudes • primary care as ‘gatekeeper’ • less good access to diagnostics • Inferior specialist services • availability of specialist clinicians • access to treatment (e.g. high-cost, drugs; advanced radiotherapy techniques, etc.) • Statistical artefacts • Patient characteristics • high rate of co-morbidities • different disease biology (population genetic differences)

  7. Holmberg et al. Thorax, 2010;65:436-441

  8. Symptoms significantly associated with diagnosis of lung cancer (..so far) Source: R Hubbard; unpublished

  9. Record of symptoms among cases 5 years before lung cancer index date Source: R Hubbard; unpublished

  10. What are the outcomes?And what’s in the guideline? • Improved mortality • Improved survival • Improved quality of life • Improved palliation of symptoms • Improved patient satisfaction • Curative treatments • Earlier diagnosis; • More active treatment incl palliative care; HNA • Fast efficient service; good communication; caring HCP; easy access to urgent care

  11. How can we improve outcomes? • Diagnose earlier by other methods • Public awareness • Prompt recognition and referral • More CXRs • Improve the accuracy of assessment

  12. Quality Standards http://guidance.nice.org.uk/qualitystandards/qualitystandards.jsp • Based largely on NICE GL • Supposed to be aspirational • Need to be easily measurable • Limited to 15

  13. Quality Statements • 1. People are made aware of the symptoms and signs of lung cancer through local coordinated public awareness campaigns that result in early presentation. • 2. People reporting one or more symptoms suggesting lung cancer are referred within 1 week of presentation for a chest X-ray or directly to a chest physician who is a core member of the lung cancer multidisciplinary team.

  14. Quality Statements • 3. People with a chest X-ray result suggesting lung cancer have a copy of the radiologist's report sent to and followed up by the lung cancer multidisciplinary team.

  15. Quality Statements • 4. People with known or suspected lung cancer have access to a named lung cancer clinical nurse specialist who they can contact between scheduled hospital visits. • 5. People with lung cancer are offered a holistic needs assessment at each key stage of care that informs their care plan and the need for referral to specialist services.

  16. Quality Statements • 6. People with lung cancer following initial assessment and CT scan are offered investigations that give the most information about diagnosis and staging with the least risk of harm • 7. People with lung cancer have adequate tissue samples taken in a suitable form to provide a complete pathological diagnosis including tumour typing and sub-typing, and analysis of predictive markers.

  17. Quality Statements • 8. People with resectable lung cancer who are of borderline fitness and not initially accepted for surgery are offered the choice of a second surgical opinion, and a multidisciplinary team opinion on non-surgical treatment with curative intent. • 9. People with lung cancer are offered assessment for multimodality treatment by a multidisciplinary team comprising all specialist core members.

  18. Quality Statements • 10. People with lung cancer stage I-III and good performance status who are unable to undergo surgery are assessed for radiotherapy with curative intent by a clinical oncologist specialising in thoracic oncology • 11. People with lung cancer stage I-III and good performance status who are offered radiotherapy with curative intent receive planned treatment techniques that optimise the dose to the tumour while minimising the risks of normal tissue damage.

  19. Quality Statements • 12. 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. • 13. People with small-cell lung cancer have treatment  initiated within 2 weeks  of the pathological diagnosis

  20. Quality Statements • 14. People with lung cancer are offered a specialist follow-up appointment within 6 weeks of completing initial treatment and regular specialist follow-up thereafter, which can include protocol-led clinical nurse specialist follow-up. • 15. People with lung cancer have access to all appropriate palliative interventions delivered by expert clinicians and teams.

  21. Quality Statements – what’s missing? • Specific Palliative Care recommendations • Covered by generic QS • Palliative Care • Patient experience • Specific recommendations on communication • Covered by generic QS • Patient experience

  22. Lung cancer mortality - NLST p = 0.004 NNT = 320

  23. Cumulative Numbers of Lung Cancers and of Deaths from Lung Cancer. The National Lung Screening Trial Research Team . N Engl J Med 2011;365:395-409.

  24. Summary Quality Service Value for money Reduced emergency admissions; longer survival; more active treatment. Longer survival; reduced mortality; less futile surgery; Longer survival; Better quality of life; better choices • Awareness and prompt action • Accurately assessing patients for treatment • Curative surgery where possible • Alternative curative treatments • Targeted systemic therapy • Small cell treatment rapidly • Holistic needs assessment • Palliative interventions by expert teams • Offering regular follow-up

More Related