Exploring variations in lung cancer care across the UK--the 'story so far' for the National Lung Cancer Audit

Abstract

The National Lung Cancer Audit was developed to improve the quality and outcomes of services for patients with lung cancer, knowing that outcomes vary widely across the UK and are poor compared to other western countries. After five years the audit is capturing approximately 100% of the expected number of incident cases across hospitals in England, Wales, Scotland, Northern Ireland and Jersey. Measures of process and outcome have improved over the audit period, such as the histological confirmation rate (64-76%), the proportion of patients discussed in a multidisciplinary team meeting (78-94%), and the proportion of patients having anti-cancer treatment (43-59%), surgical resection (9-14%) and small cell lung cancer chemotherapy (58-66%). These national averages hide wide variations between hospitals providing lung cancer care which cannot be accounted for by differences in casemix. This paper describes the evolution of the audit, and describes the ways in which it may have improved clinical practice.

Fig 1.

Graph showing variation in casemix-adjusted histological confirmation by cancer network. Results are given as odds ratio for histological/cytological confirmation of the diagnosis after adjustment for age, sex, stage, performance status and socioeconomic status.

Fig 2.

Graph showing variation in casemix-adjusted treatment rates by cancer network. Results are given as the odds ratio for anticancer treatment (a), surgical resection in non-small cell lung cancer (b) and chemotherapy in small cell lung cancer (c) after adjustment for age, sex, stage, performance status and socioeconomic status.

Fig 3.

Graph showing variation in casemix-adjusted mortality by cancer network. Results are given as the hazard ratio for mortality based on median survival after adjustment for age, sex, stage, performance status and socioeconomic status.