National Lung Cancer Audit

National Lung Cancer Audit – second organisational audit

Posted by Bhavani Adizie on Monday 29 January, 2018

Clinical research fellow, Bhavani Adizie, looks at the results from our second organisational audit and how they compare to results from 2014.

In May 2017, we announced that we were about to embark on the second National Lung Cancer Audit (NLCA) organisational audit. Now that 2017 has whizzed by, you may be wondering what we have done and what our results were. Having briefly outlined some of the key results at the British Thoracic Society (BTS) lung cancer and mesothelioma specialty advisory group (SAG) meeting, I would like to now share our results with you in more detail.

We conducted the second organisational audit in 2017 because the first organisational audit (completed in 2014) demonstrated significant variation in access to diagnostics, treatment modalities and treatment specialists. The results of the first audit were published in Thorax and concluded with five recommendations. The second audit reassessed how we are doing against those recommendations, with the aim of guiding policy and recommendations about the minimum requirements that make a safe and effective lung cancer service.

The response rate was 86%, which was an improvement from the 57% response rate for the 2014 survey.

Bhavani Adizie, clinical research fellow

What have we done?

In March 2017 we updated the survey questions, based on feedback from the first audit, and we developed a bespoke online survey tool and accompanying ‘help notes’. The survey was piloted at five sites and it was further modified according to the feedback we received. The survey went live in June 2017 and the response rate was 86%, which was an improvement from the 57% response rate for the 2014 survey. (Thank you to all the teams that participated!) The process of data checking and verification began, and we found a wide variability in staffing reporting. To gain an accurate picture, we emailed all lung cancer clinical leads to ask them to verify their data. In total, 97 units were contacted, with a 35% response rate.

What have we found?

The table below compares the second organisational audit results with the 2014 audit recommendations.

Recommendation 2014 n (%) 2017 n (%)
Maximum of 30 patients discussed per MDT meeting 75 (74%) 91 (69%)
Diagnostic and non-cancer cases discussed at a seperate MDT meeting 29 (29%) 57 (43%)
Lung CNSs workload should not exceed 80 cases per whole time equivalent per year 16 (20%) 24 (18%)
All lung MDTs should have access to all diagnostic tests 79 (85%) 99 (77%)
All treatment modalities should be available to all patients 84 (90%) 116 (90%)
All trusts should participate in the next round of the national lung cancer organisational audit 101 (57%) 132 (83%)

Other interesting key results include the following:

  • Overall, 86% of providers (85% for England; 92% for Wales) participated in the second NLCA organisational audit.
  • The number of providers that have a separate diagnostic multidisciplinary team (MDT) meeting increased from 29% to 43%.
  • One-third of providers discuss more than 30 patients on each MDT meeting list.
  • The provision of on-site endobronchial ultrasound (EBUS) has increased from 44% to 67% in 3 years.
  • In the past 3 years, there has been a decrease in access to on-site pulmonary rehabilitation (81% to 67%) and smoking cessation services (86% to 67%).

We also looked at how units are doing compared with the standards set out in the newly published national commissioning guidance. This is summarised below:

Recommendation 2017 n (%)
1 WTE respiratory physician (10 PA) per 200 new diagnoses per year 79 (60%)
Radiologist with 1/3 of their job plan devoted to thoracic imaging 107 (81%)
Medical oncologist with 1/3 of their job plan devoted to lung cancer 77 (58%)
Clinical oncologist with 1/3 of their job plan devoted to lung cancer 90 (68%)
1 WTE LCNS per 80 new diagnoses per year 24 (18%)

If stroke can do it, so can we!

Bhavani Adizie, clinical research fellow

What does this all mean?

Access to some diagnostics is improving, such as the availability of on-site EBUS. However, there is still unwarranted variation in resources, particularly in terms of staffing provision. Therefore, we have made the following four recommendations that align with the national commissioning guidance.

  • 1. All patients should have access to local smoking cessation and pulmonary rehabilitation services.
  • 2. All core MDT members should have dedicated time to attend a weekly MDT meeting, at which they discuss no more than 30 patients in 2 hours.
  • 3. All MDTs should ensure they have adequate specialist time commitment, as specified in the national commissioning guidance, with a particular focus on lung cancer nurse specialists.
  • 4. All providers that do not have a separate diagnostic MDT should establish one within the next 12 months, as specified in the new commissioning guidance.

What does this mean for MDTs?

We will soon send units their individual results and explain how they compare with the national results. I hope that the results will allow MDTs to begin discussions with local commissioners / hospital managers about how local resources and staffing can be improved to align with the recommendations.

We are in exciting times for lung cancer research, with improvements in diagnostics and treatments occurring at an impressive pace. However, in order for our patients to get the best out of this modern practice of thoracic oncology, we need to ensure that our workforce and resources are organised to allow all patients to have timely access to diagnostics and treatments.

The results from the stroke organisational audit contributed to a change in the organisation of stroke services, which was shown to improve patient outcomes. If stroke can do it, so can we!

Dr Bhavani Adizie, Research Fellow

Copyright © 2021 National Lung Cancer Audit