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

Network Audit 2011-12
Patients with Confirmed Small Cell Lung Cancer
Who Did Not Receive Chemotherapy
Dr D N Leitch
On 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
Code
RE9
RLN
RNL
RR7
RTD
RTF
RTR
RVW
RXP
N36 Total
LUCADA
Total
Actual
number
181
273
232
221
317
343
351
314
424
2,656
32,347
Number of patients small cell % small cell receiving
lung cancer
chemotherapy
12
33
34
26
43
38
47
29
45
307
3,585
50.0%
69.7%
52.9%
69.2%
74.4%
57.9%
59.6%
65.5%
62.2%
63.2%
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 Expected
Trust (N36)
Number of Cases Small Cell
Small Cell
Chemotherapy
Rate
Expected Number Number in
in Audit
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%)
307
63.2% 113
80 (71%)
National
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
All
Median 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 – preupload review may significantly improve NLCA data values
• Almost all patients discussed at MDT meetings
• Almost all patients had a CT
Conclusions
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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?