Download document - Herts Valleys CCG

Lung Cancer Audit in Primary Care Feedback
June 2016
1. Introduction
The National Lung Cancer Audit data in 2013 and 2014 showed West Herts Hospital Trust (WHHT) to
be poorly performing in a number of areas including low treatment rates.
To review and improve this data the Cancer Action Group (CAG) has worked with WHHT on a
number of areas including:
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Review of National Lung Cancer Audit data to ensure accuracy
Primary care audit of lung cancers diagnosed at a late stage
Review of lung cancer pathway
The below is a summary of the lung cancer audit in primary care
2. Results
The CAG wanted to fully understand why patients are not being offered anticancer treatments and
one reason for this may be because they are presenting late with advanced stage disease. So
alongside the challenge to the WHHT’s MDT we have carried out an audit of patients presenting with
late stage disease to try to determine what factors contributed to this. In particular:
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Are there any systematic delays in the processes?
Is primary care failing to investigate or refer appropriately?
It was felt that the audit would help to answer these questions, through analysing how well primary
care are complying with NICE referral guidelines for suspected lung cancer and from this to identify if
any changes can be made.
The population being audited was all patients referred to WHHT between 1st January 2014 and
31stDecember 2014 with late stage lung cancer at point of referral. Late stage lung cancer is defined
as stages 3a, 3b or 4 lung cancer.
The audit used information from GP records. WHHT provided the public health team with a list of
patients meeting the criteria for inclusion in the audit. The criteria for inclusion were:
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Diagnosed with pre-treatment stage 3 or stage 4 lung cancer
Diagnosed between 1 January and 31 December 2014
Resident of the area covered by Herts Valleys CCG.
The referring GP for each of these patients received a letter from the public health team (and
supporting letter from Herts Valleys CCG) asking them to complete an audit questionnaire.
There were 75 patients from 37 GP practices identified by WHHT as being referred to WHHT with
late stage lung cancer in 2014. All practices were contacted and asked to complete audit
questionnaires for their patients.
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The audit received a 53% response rate from primary care and the CAG acknowledge that there are
limitations performing case reviews/analysis in this way.
3. Emerging themes
The initial findings from this audit have revealed the following emerging themes which may need
further investigation:
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Several patients had clear chest x-rays in the months prior to diagnosis
Need greater understanding in relation to complex patients and whether GPs are
referring this group appropriately.
More detailed results are available in the full audit report which is available upon request via
[email protected]
4. Actions
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Primary care to order CT scan (noting that it is for a 2 week wait appointment) when
referring for a 2 week wait appointment for suspected lung cancer

The CAG will continue to work with WHHT on the early diagnosis of patients with lung
cancer and particularly reviewing patients where there has been a clear x-ray in months
prior to diagnosis to understand if there is more that can be done.

The CAG will continue to work with WHHT to develop the lung cancer pathway including
ensuring all patients have a CT scan before their 2 week wait appointment, to shorten the
patient pathway.
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At the next CAG in June the National Lung Cancer Data will be further reviewed once
additional information has been provided by the Mount Vernon Cancer Centre.
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