Network Audit 2011-12Patients with Confirmed Small Cell Lung Cancer

Who Did Not Receive Chemotherapy

Dr D N LeitchOn Behalf of Lung Cancer NSSG

NECN

Introduction

• National Lung Cancer Audit - “Chemotherapy rates for small cell lung cancer below the England and Wales average of 65 per cent should be reviewed”

• Important clinical line of enquiry used in Peer Review• Required consideration in annual self assessment report• If gone as far as confirming diagnosis – Why no treatment?

NLCA Results 2010 Patients

CodeActual number

Number of patients small cell lung cancer

% small cell receiving chemotherapy

RE9 181 12 50.0%RLN 273 33 69.7%RNL 232 34 52.9%RR7 221 26 69.2%RTD 317 43 74.4%RTF 343 38 57.9%RTR 351 47 59.6%RVW 314 29 65.5%RXP 424 45 62.2%N36 Total 2,656 307 63.2%LUCADA Total

32,347 3,585 65.1%

Methods

• Retrospective case note audit • All Trusts participated• Patients diagnosed with lung cancer during 12 months

01.01.2010 to 31.12.2010 • Results match the current 2011 National Lung Cancer Audit

(NLCA) report for 2010 patients • Results submitted to NECN, collated and analysed

Number of Cases in Audit vs ExpectedTrust (N36) Number of Cases

Small CellSmall Cell Chemotherapy Rate

Expected Number in Audit

Number in Audit

RE9 12 50.0% 6

RLN 33 69.7% 10 8 (80%)

RNL 34 52.9% 16 9 (56%)

RR7 26 69.2% 8 7 (88%)

RTD 43 74.4% 11 9 (82%)

RTF 38 57.9% 16 8 (50%)

RTR 47 59.6% 19 15 (79%)

RVW 29 65.5% 10 7 (70%)

RXP 45 62.2% 17 17 (100%)

National 307 63.2% 113 80 (71%)

NECN 3,585 65.1% 2334

Results

• Patient characteristics• Investigation• Treatment

Median Age = 74 years (IQR 66-90)

CT Performed and MDT Discussion

Survivors >100 days vs All Patients

>100 days survival AllMedian Age (IQR) 78.5 (70-90) 74.0 (66-90)

M:F 5:11 (45%) 30:49 (38%)

Co-morbidity 14:2 (87.5%) 57/80 (71%)

Stage 3b,4 12/16 (75%) 69/80 (75%)

Performance Status 3,4 8/16 (50%) 51/80 (64%)

Chemotherapy discussed 14/15 (88%) 62/77 (81%)

Chemotherapy refused 7/10 (70%) 20/57 (35%)

Seen by Oncologist 10/16 (63%) 47/79 (60%)

Treated with radiotherapy 10/16 (63%) 22/47 (46%)

Conclusions

• NLCA data collection is improving each year – Good quality comprehensive data important

• Process of audit is most valuable in reflecting on current practice– Surgical resection, histological confirmation, SCLC Chemotherapy

• Actual figures in audit are not the figures reported in NLCA – pre-upload review may significantly improve NLCA data values

• Almost all patients discussed at MDT meetings• Almost all patients had a CT

Conclusions

• Median age was 74 years • Too many (44%) presented as emergencies vs 41% as 2WR• Too many had poor WHO PS – 64% WHO = 3 or 4• Significant Co-morbidity 71%• 81% Chemotherapy discussed with patient• 25% patients refused chemotherapy• 60% seen by oncologist• If no chemotherapy – about 25% had radiotherapy• Longer survivors – older, more co-morbidity, better WHO-PS

more likely to refuse chemotherapy

Actions

• Review data before uploaded if possible• Ensure older patients with co-morbidity and better WHO – PS

have full discussion, offer of chemotherapy and review with oncology

• - Other suggestions?