Download Delivery of systemic therapy in NSCLC

Delivery of systemic therapy in
Gloucestershire
for NSCLC
Nina Reeve
Fiona Young
Sam Guglani
Lung Cancer Business Meeting
Thursday 11th February 2016
Redwood Education Centre GRH
NICE Guidance 2011
• 1.4.40 Chemotherapy should be offered to
patients with stage III or IV NSCLC and good
performance status (WHO 0 or 1)
• 1.4.41 Chemotherapy for advanced NSCLC
should be a combination of a single thirdgeneration drug plus a platinum drug
2
10th National Lung Cancer Audit Report 2014
(2013 audit period)
10th National Lung Cancer Audit Report 2014
(2013 audit period)
• 39 000 patients/ 100% secondary care lung cancer
• Investigate chemo rates below England & Wales averages:
– SCLC 70%
– NSCLC 60% (PS 0/1 Stage IIIb/IV)
10th National Lung Cancer Audit Report 2014
(2013 audit period)
• 39 000 patients/ 100% secondary care lung cancer
• Investigate chemo rates below England & Wales averages:
– SCLC 70%
– NSCLC 60% (PS 0/1 Stage IIIb/IV)
62%
37%
10th National Lung Cancer Audit Report 2014
(2013 audit period)
A self-assessment of the GH NHS FT lung cancer MDTs against the NICE lung
cancer quality standards.
QS12
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.
Non-compliant – we have the lowest rate of this treatment of any trust in the
South West, and the old 3-counties region had the lowest rate of any region
in the whole country.
Action: An audit is urgently required to examine the underlying reasons for
this.
Delivery of systemic
chemotherapy in NSCLC
Audit
February 2016
7
Aim
• Are we offering chemotherapy to stage 3b/4
NSCLC patients with a PS of 0/1 as per NICE
guidance
• Are we reaching the standards set by the 10th
lung cancer audit
8
Method
•
•
•
•
•
GHT and CGH Lung cancer MDTs
All NSCLC registered in 2014
Stage 3b/4
PS 0/1 as documented by MDT
Opmas for registration clinic letters and
chemotherapy regimes
9
Results
•
•
•
•
•
GHT and CGH Lung cancer MDTs
All NSCLC registered in 2014
Stage 3b/4
PS 0/1 as documented by MDT
Opmas for registration clinic letters and
chemotherapy regimes
• 59 patients
10
Demographics
Age
Sex
40
35
10%
16%
40%
42%
30
18%
30%
50-59
25
60-69
20
70-79
15
80-89
10
5
0
Male
female
11
Stage and Intent
Stage
Intent
45
60
40
50
35
30
40
25
30
20
15
20
10
10
5
0
0
3b
4
Radical
Palliative
12
Performance
status
 6 pts were changed from PS
0/1 to a 2 or 3 and so were not
eligible for further inclusion
 PS not stated in 3 pts so
excluded
 50 patients
60
50
40
MDT PS
Onc PS
30
20
10
0
0/1
Not
stated
13
Patient pathway




Time from MDT discussion to seeing an oncologist;
Mean 15 days
22% were seen before MDT
Range 2-55 (2-26)
 Time to receiving chemotherapy from 1st oncologist appointment
 Mean 22 days
 Range 8-53 days (8-39)
 Time from MDT to receiving treatment
 Mean 37 days
 Range 2-55 days (2-39)
14
Chemotherapy and Systemic
treatment
5
(10%)
19
(38%)
26
(52%)
Chemotherapy
No chemotherapy
Tarceva
15
Documented reason for no chemotherapy
 53% received RT upfront for local symptoms including pain
(8 received thoracic RT (2 refuse chemo, 1 had chemo
subsequently), 3 received WBRT)
 26% had an egfr mutation and received a TKI
 16% had a change in their PS deeming them unfit for
chemotherapy
 4% had comorbidities
16
Survival (months)
No chemo
14
Chemo
Number of Patients
12
10
8
Linear (No
chemo)
6
Linear
(Chemo)
4
2
0
-2
0 to 3
3 to 6
6 to 9
9 to 12 12 to 15 15 to 18
Months
18+
17
Summary
• 52% of patients who were PS 0 or 1 at diagnosis received a
platinum based chemotherapy
• 10% had other systemic treatment – TKI etc
• 62% of patients with PS 0/1 received systemic therapy
• 16% of pts that were PS 0/1 at diagnosis had deteriorated by
the time they were due to begin chemotherapy
• Those receiving primary RT for symptoms made up the largest
group of patients not receiving immediate chemo (11) – 1
went on to receive chemo
18
SACT 30 Day post-chemotherapy mortality
SACT 30 Day post-chemotherapy mortality
• Lung Palliative
– 1 death/ 1 patient
[100% 30 day death rate]
SACT 30 Day post-chemotherapy mortality
Lung, palliative* intent
Other trusts
Average (9.5%)
3SD limits
Gloucestershire Hospitals NHS Foundation Trust
2SD limits
100
% 30 day post-chemotherapy mortality
90
80
70
60
50
40
30
20
10
0
0
100
200
SACT (January 2014 to December 2014)
300
400
500
Total Number of Patients
600
700
SACT 30 Day post-chemotherapy mortality
• Lung Palliative
– 1 death/ 1 patient
[100% 30 day death rate]
– 15 death/ 205 patients [7.3% 30 day death rate]
Discussion
• Could oncology see pts sooner to avoid delays in
commencing definitive treatment
– Combined lung clinic
• Can we more accurately determine PS documented by
MDT?
• Audit highlighted the importance of accurate prospective
data collection
– Understand patterns of service provision
– Ultimately improve patient care
23
Thank you for listening
Any questions?
24