## National Lung Cancer Audit National Lung Cancer Audit Report For The Audit Period 2015 National Lung Cancer Audit Annual Report 2015 (For The Audit Period 2014)

In association with:

## The Royal College Of Physicians

The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in over 
30 medical specialties with education, training and support throughout their careers. As an independent charity representing more than 30,000 fellows and members worldwide, we advise and work with government, patients, allied healthcare professionals and the public to improve health and healthcare. 

The Clinical Effectiveness and Evaluation Unit (CEEU) of the RCP delivers projects that aim to improve healthcare in line with the best evidence for clinical practice: guideline development, national comparative clinical audit, the measurement of clinical and patient outcomes, and change management. All of our work is carried out in collaboration with relevant specialist societies, patient groups and NHS bodies.  
Healthcare Quality Improvement Partnership The National Lung Cancer Audit is commissioned by the Healthcare Quality Improvement Partnership 
(HQIP) as part of the National Clinical Audit (NCA) Programme. HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the NCA Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. 

Citation for this document: Royal College of Physicians. National Lung Cancer Audit annual report 2015 
(for the audit period 2014). London: Royal College of Physicians, 2015. 

Copyright All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner's written permission to reproduce any part of this publication should be addressed to the publisher. 

Copyright © Healthcare Quality Improvement Partnership 2015 ISBN 978-1-86016-591-7 
eISBN 978-1-86016-592-4 
Royal College of Physicians 
11 St Andrews Place Regent's Park London NW1 4LE 
www.rcplondon.ac.uk Registered Charity No 210508 

| Document purpose                                                             | To disseminate results on the quality of care of lung cancer care for patients    |
|------------------------------------------------------------------------------|-----------------------------------------------------------------------------------|
| diagnosed in the period between 1 January and 31 December 2014               |                                                                                   |
| Title                                                                        | National Lung Cancer Audit annual report 2015 (for the audit period 2014)         |
| December 2015                                                                |                                                                                   |
| Author                                                                       | Royal College of Physicians, Clinical Effectiveness and Evaluation Unit           |
| Publication date                                                             | December 2015                                                                     |
| Target audience                                                              | General public; lung cancer patients, their families and their carers; NHS staff  |
| in lung cancer multidisciplinary teams; hospital managers and chief          |                                                                                   |
| executives;                                                                  | c                                                                                 |
| Description                                                                  | This is the 11th report on the clinical component (process of care) of the        |
| National Lung Cancer Audit. It publishes national and named team results on  |                                                                                   |
| the quality of lung cancer care for patients diagnosed between 1 January and |                                                                                   |
| 31 December 2014. It covers many processes of care across the entire patient |                                                                                   |
| pathway.                                                                     |                                                                                   |
| Related publications                                                         | NICE Quality Standard for Lung Cancer 2012:                                       |
| www.nice.org.uk/guidance/qs17                                                |                                                                                   |
| National Lung Cancer Audit annual report 2014:                               |                                                                                   |
| www.rcplondon.ac.uk/projects/outputs/nlca-annual-report-2014                 |                                                                                   |
| Contact                                                                      | nlca@rcplondon.ac.uk                                                              |

Commissioned by: 
National Lung Cancer Audit annual report 2015 (for the audit period 2014) 
Report prepared by: Rosie Dickinson National Lung Cancer Audit project manager, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Dr Ian Woolhouse Consultant respiratory physician, senior clinical lead Dr Paul Beckett Consultant respiratory physician, clinical lead Dr Mick Peake Consultant respiratory physician, clinical lead Rhona Buckingham  
Royal College of Physicians Sally Vernon National Cancer Registration Service Natasha Wood National Cancer Registration Service Margreet Luchtenborg National Cancer Intelligence Network Professor Richard Hubbard University of Nottingham Aamir Khakwani University of Nottingham Thank you to all the lung cancer teams that have contributed data to the audit; without your considerable efforts, this report would not be possible. 

## Foreword

These are exciting times in lung cancer, with the development of a number of novel therapies that may revolutionise treatment paradigms for the future. However, we should not lose sight of the fact that thousands of lives could be saved if the standard of lung cancer care across the country achieved that of the best-performing hospitals. 

In December 2014, the Royal College of Physicians (RCP) was awarded the new contract to deliver the National Lung Cancer Audit (NLCA) in England and Wales for the next 3–5 years. Working in partnership with our key stakeholder organisations, we are determined to work together with lung cancer teams to maintain excellent levels of engagement and to go even further to improve outcomes for patients. 

I am delighted that we have been able to produce a report relating to patients seen in 2014, but I am very aware that our first report is transitional in nature. Lung cancer teams and our partners at the National Cancer Registration Service (NCRS) and the University of Nottingham have worked incredibly hard to submit and analyse the data. It is testament to this hard work that we have near-complete population coverage again this year. While there may have been a slight dip in data quality, this dataset remains one of the most complete cancer datasets in the world. However, there is no room for complacency. From the beginning of 2015, all lung cancer audit data in England will come to us via a brand new route - the Cancer Outcomes and Services Dataset (COSD). We must ensure that this switch does not negatively impact on data quality or distract us from our key aim of improving outcomes for lung cancer patients. Indeed, the data presented in this report highlight that a number of organisations still have work to do to achieve the audit standards that were set in 2014. 

We have set new standards for 2016 onwards that are deliberately stretching, but also include new measures to cover more areas of the diagnosis and treatment pathway. We are appointing a new clinical co-lead with an interest in quality improvement, and plan to pilot a deep-dive audit function to help trusts to achieve these new standards. Another exciting development is the opportunity to explore the feasibility of collecting patient-reported outcomes as part of the audit for the first time. 

Finally, I would like to acknowledge the outstanding contribution to the audit of Dr Mick Peake, who is stepping down at the end of this year. Under his leadership over the last 10 years, the NLCA has set the standard for cancer audits and I am confident that we can continue to do so over the next 10 years. 

Dr Ian Woolhouse Senior clinical lead, National Lung Cancer Audit 

## Executive Summary

This report summarises the key findings from the 11th annual National Lung Cancer Audit (NLCA) for patients diagnosed with lung cancer in England, Wales, Guernsey and Scotland in 2014. The purpose of the audit is to review the quality of lung cancer care, to highlight areas for improvement and to reduce variation in practice. 

Lung cancer is the second most common cancer in the UK after breast cancer. In 2012, there were over 
40,000 new cases of lung cancer in the UK and more than 35,000 people died from the condition. Current survival rates for lung cancer are the second lowest out of 20 common cancers in England and Wales.1 
The NLCA has been collecting data since 2005 and has become an exemplar of national cancer audit; it currently forms part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) commissioned by the Healthcare Quality Improvement Partnership (HQIP). NLCA data have been widely disseminated though abstracts at national and international meetings and in peer-reviewed publications. Local data have been used as a driver for local service improvement projects. The data have also been used to underpin National Institute for Health and Care Excellence (NICE) guidelines, to inform research protocols and to guide national service developments. 

In late 2014, the contract for the NLCA was awarded to the Royal College of Physicians (RCP) and is now delivered in partnership with a number of key stakeholders. The National Cancer Registration Service (NCRS) at NHS England collects and processes the NLCA data for England through the Cancer Outcomes and Services Dataset (COSD). This replaces the previous bespoke dataset submitted by trusts through a web portal (LUCADA). The University of Nottingham, subcontracted through the RCP, provides the analysis for England and Wales. Clinical leadership is provided by lung cancer experts recruited through the Clinical Effectiveness and Evaluation Unit at the RCP.   
The NLCA executive group is constituted by the Society for Cardiothoracic Surgery (SCTS), the Roy Castle Lung Cancer Foundation representing lung cancer patients, the Welsh Lung Cancer Special Advisory Group, the National Lung Cancer Forum for Nurses and the British Thoracic Oncology Group. 

## Overview Of The Results

To maximise a focus on data quality during this year of transition, organisations were asked to submit a limited number of key data items for 2014. Trusts2 in England were offered the opportunity to submit their LUCADA data files for the NLCA via the NCRS, in order to supplement their COSD submissions. 

Despite a transitional year, participation in the audit by lung cancer services in England, Guernsey, Scotland and Wales has been outstanding, collectively contributing data on over 37,000 patients diagnosed with the disease in 2014. It has proved more difficult than anticipated for the NLCA team to collate data for trusts in England from both LUCADA and COSD submissions within the timeline of the report. Therefore, for this annual report we include the 2014 results from 132 trusts that submitted LUCADA data. Early in 2016, we will produce an online appendix for the remaining 19 trusts that submitted COSD submissions only. 

Scottish data are not submitted at an individual patient level and so 'national' results noted below represent the overall picture across England, Wales and Guernsey. Notwithstanding possible data quality issues relating both to non-participating English trusts and to data quality issues in participating trusts, the results this year show a fall in a number of markers of clinical quality of lung cancer services. There is room for improvement in a number of key areas where organisations did not meet the measures recommended in the 2014 report. 

2014 recommendation: Data completeness for key fields to exceed 85%. 2015 result: Overall recordings of key data items continue to be of a high standard: 89% of submitted records included performance status and 92% included disease stage; 84% included both items. 2014 recommendation: Maintain the level of 95% of patients submitted to the audit discussed at a multidisciplinary team (MDT) meeting. 2015 result: 94% of cases submitted were recorded to have been discussed in an MDT meeting. 2014 recommendation: Pathological confirmation rates below 75% should be reviewed to determine whether best practice is being followed. 2015 result: 69% of cases submitted were recorded to have a pathological confirmation of their cancer. 2014 recommendation: At least 80% of patients are seen by a lung cancer nurse specialist (LCNS). 2015 result: 78% of patients were recorded to have seen a specialist nurse (although 13% of cases were missing this information). 2014 recommendation: Active anticancer treatment rates below the England and Wales average of 60% should be reviewed. 2015 result: 58% of patients were recorded to have had anticancer treatment. 2014 recommendation: Chemotherapy rates for small-cell lung cancer (SCLC) below the England and Wales average of 70% should be reviewed. 2015 result: 68% of patients with SCLC were recorded to have had chemotherapy.  
2014 recommendation: Chemotherapy rates for good performance status (PS 0–1) stage IIIB/IV non-small-cell lung cancer (NSCLC) below the England and Wales average of 60% should be reviewed. 2015 result: 58% of patients with good PS and stage IIIB/IV NSCLC were recorded to have had chemotherapy.  

## Outlier Process

There are four treatment measures shown as unadjusted and adjusted in the report; for the latter we have not provided confidence intervals, but have used red/amber/green (RAG)-rated icons to indicate the significance. 

As not all trusts in England have been included in the data analysis for this report, a formal outlier identification process has not been undertaken. 

Survival data, population coverage and data field completeness rates will be available for organisations to review online, and these should be considered when cross-referencing results.  

## Plans For 2016 Onwards

We have updated the audit standards to included additional items relating to new diagnostic processes and treatments; these can be found within the key recommendations section. 

In early 2016, we will launch the second Lung Cancer Consultant Outcomes Publication (LCCOP) for data on resection rates and survival after surgery for primary lung cancer in England between January and December 2013. 

LCCOP is an HQIP programme relevant to thoracic surgeons and it is a national and mandatory programme for NHS hospitals in England. The report will be produced jointly by the NLCA and the SCTS. 

In addition to routine lung cancer audit activity, with the full transition into COSD data in 2016, we plan to pilot a 'spotlight' audit module for trusts in England to collect additional data items to allow them to better understand and address potential undertreatment of their lung cancer patients. This will be in the form of an online tool that will be targeted at trusts with poor performance or outcomes in a particular area. 

What do the data results mean for me? 

Patients, their families and their carers should welcome the engagement of clinical teams with the audit process, and the maintenance of high-quality data submissions in this year of transition. However, they should be concerned that significant variation still exists in the care delivered across different organisations. For example, why is a cancer diagnosis pathologically confirmed in fewer than 60% of patients in 27 organisations? 

NHS staff in lung cancer multidisciplinary teams should use the findings of this report, alongside our more detailed online analyses and the 'live' data on CancerStats, as a basis improving data quality, for clinical governance meetings and for quality improvement initiatives. We promote the concept of a 'clinical data lead' in every lung cancer multidisciplinary team - a person who understands the data, how they are collected and how they align to the national context.  
Hospital managers and chief executives should seek to understand and to challenge areas of poor performance identified in this report, and should discuss the findings with their clinical teams who know the strengths and weaknesses of the service best. Such discussions can be key in unlocking barriers to improvement. 

Commissioners in England should use this report alongside the soon-to-bereleased National Service Specification, to understand areas of weakness in provider hospitals and to ensure that the services they commission provide the highest quality. For example, why do fewer than 70% of patients see a specialist nurse in around 30 hospital trusts? 

The NLCA project team should consider how to assist provider hospitals in using the weaknesses identified to drive effective and sustainable change. For example, an online library of quality improvement success stories, or a network of clinicians with quality improvement expertise might be useful resources.   

## Key Recommendations

We make a number of specific recommendations against which we will audit, analyse and report in the next annual report. Our recommendations require change, as is true for all quality improvement (QI). 

Delivering that change is beyond the scope of this report, but we provide a toolkit (**www.rcplondon.ac.uk/nlca2015**) to assist this process. In future, the NLCA plans to support organisations to develop, implement and evaluate lung cancer QI strategies using NLCA data.  

## Data Completeness

1 
Organisations should work to maintain or improve the quality of data submitted to the NLCA, 
including detailed clinical data to allow the most accurate risk adjustment to be carried out. 
a)
Both performance status (PS) and stage should be recorded in at least 90% of cases.
b)
The 'reason for no anticancer treatment' field of COSD should be completed in
100% of relevant patients.
c)
For patients with stage I–II and PS 0–1, completeness for FEV1 and FEV1% should
exceed 75%.
2 
All MDTs should appoint a 'clinical data lead' with protected time to allow promotion of data 
quality, governance and QI (to be measured through future rounds of organisational audit). 

## Process Of Care

3 
Pathological confirmation rates below 75% should be reviewed to determine whether best 
practice is being followed and whether patients have effective access to the whole range of biopsy techniques. 
4 
Non-small-cell lung cancer, not otherwise specified (NSCLC NOS) rates of more than 15% should be reviewed to ensure that best practice histological diagnostic techniques including immunohistochemistry are being followed, in order that patients receive appropriate chemotherapy regimens. 
5 
At least 90% of patients are seen by an LCNS; at least 80% of patients should have an LCNS 
present at the time of diagnosis. 
6 
For patients undergoing bronchoscopy, at least 95% should have a CT (computerised 
tomography) scan prior to the procedure. 

## Treatment And Outcome

7 
MDTs with lower than expected surgical resection rates for NSCLC (below 16% or low odds 
ratio after casemix adjustment) should perform detailed case-note review to determine why 
each resectable patient did not receive an operation, including whether a section opinion was offered to borderline fit patients. 
8 
MDTs with lower than expected active anticancer treatment rates (below 60% or low odds ratio after casemix adjustment) should perform detailed case-note review to determine why 
patients with good PS did not receive active anticancer treatment. 
9 
MDTs with lower than expected chemotherapy rates for SCLC (below 70% or low odds ratio 
after casemix adjustment) should perform detailed case-note review to determine why each 
SCLC patient did not receive chemotherapy. 
10 
MDTs with lower than expected chemotherapy rates for good PS (0–1) stage IIIB/IV NSCLC 
(below 60% or low odds ratio after casemix adjustment) should perform detailed case-note 
review to determine why each advanced NSCLC patient with good PS did not receive 
chemotherapy. 

## Purpose And Background

The NLCA was developed in response to the finding in the late 1990s that outcomes for lung cancer patients in the UK lagged behind those in other westernised countries, and varied considerably between organisations. The audit began collecting data nationally in 2005, and since then has become an exemplar of national cancer audit. 

The purpose of this document, the 11th NLCA annual report, is to summarise the key findings of the audit for patients diagnosed with lung cancer across the UK in 2014. More extensive analyses of the data, including casemix-adjusted data, in an electronic spreadsheet format will be available from the RCP website at **www.rcplondon.ac.uk/nlca2015**. 

## Background To The Audit

The NLCA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS 
England in response to the need for better information about the quality of lung cancer services and care provided in England and Wales.  
HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk Until the end of 2014, the contract was held by the HSCIC. In 2014, HQIP opened a retendering process to run the audit for the next 3–5 years. The contract was awarded to the RCP, which now works in partnership with the NCRS, the Division of Epidemiology and Public Health at the University of Nottingham, the National Lung Cancer Forum for Nurses (NLCFN), the Society for Cardiothoracic Surgery 
(SCTS), the British Thoracic Oncology Group (BTOG), the Roy Castle Lung Cancer Foundation and the Welsh Lung Cancer Special Advisory Group to deliver the audit (Appendix 3).  
We have defined seven overarching questions that guide the data collection and reporting in the audit: 

## Dataset

The aim of the NLCA is to drive further improvements in lung cancer care and outcomes by bringing the standard of all lung cancer MDTs up to that of the best. Dr Ian Woolhouse The NLCA in England now uses the COSD as its primary data source (www.ncin.org.uk/collecting_and_using_data/ 
data_collection/cosd). This is a revised generic cancer registration dataset with additional clinical and pathology site-specific data items relevant to different tumour types. 

The COSD specifies the items to be submitted electronically by service providers to the NCRS on a monthly basis. The COSD also identifies the items that the NCRS will obtain from other sources, such as cancer waiting times and the Office for National Statistics. 

Historically, the NLCA used a bespoke dataset submitted through a web portal (known as LUCADA - 
LUng CAncer DAta); although from the time of the introduction of the COSD in 2013, organisations submitted data through both routes, the LUCADA dataset was considerably more complete. Following transfer of the contract to the RCP, the web portal was shut down, and so as not to lose the opportunity to use the LUCADA data collected through 2014, organisations were offered the opportunity, for this year of transition only, to submit their LUCADA data to the NCRS; 132 of 151 English trusts submitted a LUCADA data file (see below). Furthermore, the project team advised organisations to focus on a restricted number of data items in order to maximise the quality of data on the most critical clinical measures. We do appreciate that, in this time of transition, data quality has deteriorated somewhat and individual organisations should take this into account in their response to the report findings. 

For Wales, Scotland and Guernsey, the dataset and data transfer arrangements are unchanged. In Wales, data are collected through the Cancer Network Information System Cymru (CANISC) and patientlevel data are submitted to the NLCA; likewise, in Guernsey, patient-level data are collected and submitted to the analysis team. Scottish data are collected and analysed locally; thus summary, rather than patient-level, data are submitted for inclusion in the report. It is for this reason that Scottish results may appear separate in this report. 

## Reporting

This report covers patients with a diagnosis of cancer that has been classified with code C33–C38 of the 
10th edition of the World Health Organization International Classification of Disease (WHO ICD-10). We have excluded mesothelioma (C45) from the main report, having published a mesothelioma-specific report earlier in 2014; plans are underway to produce a similar report in 2017 and we encourage organisations to continue to collect high-quality mesothelioma data in anticipation of this. 

In contrast to previous years of the audit, when patients were assigned to a cohort based on the year in which they were first seen in secondary care, we have moved to a cohort based on the year of diagnosis. 

Details of care provided by individual organisations in this report are based on 'place first seen' in secondary care; in the vast majority of cases, it represents the location of the MDT that coordinates the investigation and treatment of the individual patient. As a result, some tertiary trusts in England may appear to have little input into the care of lung cancer and to submit little data to the audit; however, on the contrary, they often provide the most complex care for the most difficult-to-treat patients and submit treatment data on behalf of other trusts. 

Participation in the audit by lung cancer services in England, Guernsey, Scotland and Wales has been outstanding, collectively contributing data on over 37,000 patients diagnosed with the disease in 2014. 

Unfortunately, in this year of transition it has proved much more difficult than anticipated to bring together the very different COSD and LUCADA data sources submitted from English trusts within the necessary timeline for publication of this report. As a result, for the English data in this annual report, we have taken the decision to analyse and report on only the 132 (of 151) participating trusts that have submitted a LUCADA data file. In due course, we will bring together all of the data and provide an updated analysis online. This is in no way a reflection on the 19 trusts not included in this report that submitted COSD data in good faith.  
We report the results of the NLCA at national, strategic clinical network (SCN) and trust or health board levels. Overall national results, unless otherwise stated, represent analysis of the combined patient-level data from England, Wales and Guernsey, as Scotland currently provides only summary data. 

Quality is never an accident. It is always  
the result of intelligent effort. 

John Ruskin 

## Standards And Nice Guidelines

National guidelines produced by the National Institute for Health and Care Excellence (NICE) underpin the approach to management of patients with lung cancer in England (**http://pathways.nice.org.uk/pathways/lung-cancer**). NICE has produced a set of 15 quality standards 
(QSs) intended to describe what a high-quality lung cancer service should deliver, although they stop short of setting numerical standards. Similar standards exist in Scotland (**www.healthcareimprovementscotland.org/our_work/cancer_care_improvement/cancer_qpis.aspx**). 

Patients vary greatly in their disease profile, their fitness for investigation and treatment, and their own preferences for their care. As a result, it is not always easy to interpret the results of individual organisations. However, setting standards is an important driver of improvements in care; without standards, we cannot know which organisations are doing well and we cannot learn from them; similarly, we cannot know which organisations are performing poorly and we cannot try to help them. 

Thus, we have produced standards that reflect NICE guidelines and QSs and that have a broad clinical consensus, but we acknowledge that sometimes organisations will fall outside the 'normal range' for good reason. Our standards are not designed to encourage clinicians to overinvestigate or overtreat their patient. On the contrary, healthcare professionals must always act in the best interests of their patients and a finding of this report, for example a lower-than-expected cancer treatment rate, should not lead to a knee-jerk change in practice to treat more patients, but rather a more detailed analysis of the data to understand why the differences exist. 

In England, HQIP and the Care Quality Commission (CQC) are working to optimise the use of national clinical audit (NCA) data for both quality assurance and QI. The CQC aims to develop a robust methodology underlying the use of NCA data to better inform its hospital inspections. Concurrently, HQIP aims to develop a public-facing, online resource that provides a summarised list of key NCA data at trust level. 

The NLCA team will be participating in the first roll-out of the HQIP/CQC collaboration. Five key metrics were agreed with the NLCA executive group for use in this project: 

1 
proportion of patients alive at 1 year 
2 
proportion of patients seen by LCNS 
3 
overall surgical resection rate 
4 
NSCLC chemotherapy rate (stage IIIB/IV, PS 0–1) 
5 
SCLC chemotherapy rate.  
Once data flow to the CQC is established and the HQIP dashboard developed, data from each trust in England will be submitted to the CQC/HQIP annually after publication of the annual report. 

## Population Coverage

In 2014 there were 30,765 patient records submitted from England, 2,219 from Wales, 43 from Guernsey and 4,382 from Scotland. 

Although the numbers for England are lower than in previous years, this reflects the 19 trusts that were not included in the analysis, as well as more general issues with data submissions relating to the transition of the audit. These numbers are still estimated to represent around 98% of the expected annual incidence and probably almost all of those cases presenting to secondary care (some cases are diagnosed and treated in primary care, or are diagnosed only at a post-mortem), as has been the case for several years. Figure 3 shows the annual trend in data submissions (England and Wales combined) over time. 

## 37,409 Submitted Cases In 2014 Data Field Completeness Cancer Tnm Stage 92% Complete Performance Status

Data completeness for individual organisations is available online this year. Overall recording of key data items continues to be of a high standard; this year, 92% of submitted records include stage and 89% include PS. These figures represent a slight drop following progressive improvements in previous years (Figure 4), although it should be recognised that this is still a high level of completion compared with other cancer audits. Nationally, 43 
organisations failed to meet the target of 85% data completeness for PS and 28 failed the target for stage. 

## 89% Complete

The transition to the new audit arrangements has led to some deterioration in the quality of the data from English trusts, not just for PS and stage, but possibly also in the recording of treatment data. For this reason, organisations should take care to understand all aspects of their performance (completeness, proportions and casemix-adjusted odds ratios) before coming to conclusions about their lung cancer services. 

## Data Submission For 2015 Onwards

We recommend that organisations use the *National Lung Cancer Audit improvement toolkit* 
(**www.rcplondon.ac.uk/nlca2015**) to improve their data submissions.  
From the beginning of 2015, all data for the NLCA in England will be submitted via COSD; it will be challenging for trusts to maintain their data completeness when transitioning to this system. The online COSD portal, CancerStats, has also launched this year and is designed to collect all the reporting products from the NCRS and the National Cancer Intelligence Network (NCIN) in one easy-to-find location (N3 connection required).  

•
Data submission reports - have the data been received, have the data been received by the
deadline, is the file in the correct format?
•
Data completeness reports focus on the data items on which the NLCA team are encouraging
teams to concentrate throughout 2015 and 2016.
•
NLCA process and outcome reports are in development - these will provide further details on
key data items, such as the proportions of patients treated with surgery, chemotherapy or radiotherapy.
Viewing CancerStats provides a way to ensure that the NCRS is accurately receiving the data that trusts in England are submitting from local cancer systems. Further detail can be found via an N3 connection at: **nww.cancerstats.nhs.uk/users/sign_in**.  
Data completeness and quality are still key to the ongoing success of the NLCA and we would encourage audit participants to view their 2014 data completeness at: www.rcplondon.ac.uk/nlca2015 

## Demographics

Analysis of the data submitted to the audit allows a detailed description of the population of patients who are diagnosed with lung cancer. In this section, we provide information on the age of patients and how this has changed over recent years. We also highlight the link between deprivation and lung cancer by charting the numbers of cases by socio-economic status. Finally, we look at the influence of gender on various factors. 

NSCLC patients have a median age of 73 years at diagnosis, and SCLC patients have a median age of 69 years. Patients with carcinoid tend to be even younger at diagnosis, with a median age of 65 years. 

The chart shows how there has been a progressive reduction in the number of younger patients with lung cancer, perhaps reflecting trends in tobacco smoking. At the same time, more cases are diagnosed in older patients, which reflects our ageing population as well as better access to diagnostic techniques such as CT scanning. 

Proportionately, more lung cancer patients come from the most socio-economically deprived parts of society. This refects the link between higher rates of tobacco smoking in more socio-economically deprived populations. 

## Standards Of Care Commentary On England

This has been a very challenging year for the NLCA in England. The changes to the infrastructure place the audit in a good position to make really significant progress over the next 3–5 years, but it has taken considerable time and effort to re-establish the clinical engagement, and to implement the new data collection and data analysis methodologies. There is no doubt that this has affected the quality of the 2014 data, but in early 2015 there were fears that the 2014 data might never be collected, and so it is a fantastic achievement on the part of many, many people in lung cancer MDTs, and in the audit team itself, to have produced this report. Improving the quality of the data back to previous levels and hopefully beyond will be a major focus for the coming year.  
Emerging evidence from a variety of sources indicates a progressive improvement in outcomes for lung cancer patients in England, from a 5-year survival rate of around 7% in the 1990s to a projected rate of 
16% for patients diagnosed now. It is perhaps invidious to compare the clinical standards in this report with those of previous years in view of the drop in data quality. That said, the data as presented show more variation across the country, and a reduction in the proportion of patients getting pathological confirmation of their diagnosis (fallen from 75.1% to 70.5%), overall active treatment (fallen from 60.2% to 57.6%) and the various individual components of this since the previous audit. It is, however, gratifying to see the improvements in the refinement of the pathological diagnosis when it occurs, with the NSCLC NOS rate now standing at 12%. 

We hope and expect that our next report in 2016 will re-establish the progressive improvement that we have seen over recent years. 

Dr Paul Beckett Clinical lead, NLCA 

## Commentary On Wales

We are pleased to see that very high percentages of lung cancer patients have continued to have their diagnosis and management discussed by an MDT (99.6%) and to be supported by an LCNS (88.0%). Anticancer treatment was also good at 60.6%, and there was an increase in patients receiving surgery 
(increasing from 10.9% in last year's audit to 15.7% reported in this report). There has been an encouraging increase from 56.4% to 61.1% in the numbers of fit patients with advanced NSCLC having chemotherapy. 

These findings will feed into the Welsh Government's Lung Cancer Initiative, which has been selected as a national priority for 2015/16 and 2016/17. They will also inform the second round of peer review of lung cancer MDTs scheduled next year. Work is being planned from a public awareness campaign to critical points through the primary and secondary care clinical pathway to improve outcomes and experience for people with lung cancer in Wales. As part of this, GPs are undertaking significant event audits of each new lung cancer patient and are being supported by excellent detailed epidemiology provided by the Welsh Cancer Intelligence and Surveillance Unit.  
Dr Jane Hanson Lead adviser for cancer, Welsh Government Prif gynghorydd cancer, Llwydraeth Cymru Head of Cancer National Specialist Advisory Group Core Team, Public Health Wales Pennaeth Tim Grwp Cynghori Arbenigol Cenedlaethol Cancer, Iechyd Cyhoeddus Cymru 

## Commentary On Scotland

The Scottish Government's Better Cancer Care action plan published in 20083 included a commitment to working with clinicians to develop quality indicators for cancer services. As a result of this, the National Cancer Quality Steering Group was established to oversee the development of a small number of national, tumour-specific quality performance indicators (QPIs). The QPIs were developed by clinical staff across the three regional cancer networks in collaboration with the Information Services Division (ISD), Healthcare Improvement Scotland, the Scottish Cancer Coalition and the Scottish Government.   
The implementation and monitoring of these performance measures are underpinned by a national governance framework that includes responsibility at health board level. The financial year to March 
2014 was the first full year of QPI data collection and data were published in May 2015. There are areas where the data are immediately comparable with data collected in England and Wales; however, there are other areas where the data definitions differ and therefore any direct comparisons should be made with caution. Where possible alignment of comparable data is indicated and where data definitions and other differences pertain, it is important to refer to the detailed Scottish ISD National Dataset4 and Measurability5 documents.  
We all believe that data collection needs to be as close to real time as possible, and compared locally and nationally with agreed standards in order to drive service improvement. We therefore welcome this opportunity to showcase our data adjacent to data from England and Wales for comparison and discussion. We are now into the second year of Scottish QPI data analysis and, after a third iteration, there will be an opportunity to formally review QPIs to ensure that they continue to be clinically relevant and that they focus on those areas most important in delivering improvements to the quality of patient care.  
Not all of the QPIs are achieved across all health boards. This confirms the aspirational nature of the QPI 
targets and suggests that there are areas for improvement, particularly around surgical resection in NSCLC, chemo or radiotherapy in limited-stage SCLC and systemic anticancer therapy in NSCLC. A 
number of the more challenging QPIs are not reported here, as there are no comparable data for other areas of the UK. However, Scottish lung cancer data for all QPIs will continue to be analysed regionally on an annual basis, and nationally on a 3-yearly basis in line with the national QPI governance process. 

Health boards in Scotland will develop action/improvement plans in response to audit findings, and progress against these plans will be monitored by regional cancer networks and Healthcare Improvement Scotland. Regional networks will continue the close collaboration with the NLCA with a view to identifying further comparable measures and aligning future reporting periods. 

Colin Selby, clinical lead, SCAN Lung Group John McPhelim, clinical lead, WoSCAN 
Hardy Remmen, clinical lead, NoSCAN

## National Performance Measures

In December 2014, we published audit data on patients who were first seen in secondary care in 2013. Based on these data, we made a number of recommendations; organisational performance against these measures is detailed below. We have also indicated where these results align to NICE QSs. Results for individual organisations can be found in the next section. 

All hospitals, trusts and health boards should participate in this national audit, should submit data on all patients presenting to secondary care diagnosed with 
either lung cancer, and should complete all relevant data fields for each individual patient. 

RECOMMENDATION 
Fortunately, even in this transition year, all secondary care organisations in England, Wales, Scotland and Guernsey have contributed data to the 
audit. 
All hospitals, trusts and health boards are encouraged to submit validated data for future rounds of organisational audit. 
No organisational audit was carried out in 2014.  

Data completeness for key fields should exceed 85% and for MDT completeness should exceed 95%. 

Nationally, 89% of submitted records included PS and 92% included disease stage. 
84% of records included both of these data items. Overall, only just over 50% of trusts achieved the target for PS and stage recording. 
Data completeness for the comorbidity field should exceed 85%, and for patients with stage I–II and PS 0–1, completeness for FEV1 and FEV1% should exceed 75%. 

Data collected in this transition year do not allow the analysis of this 
measure. 

Maintain the level of 95% of patients submitted to the audit being discussed at an MDT meeting. ALIGNS TO NICE QS9 

Nationally, 94% of cases submitted were recorded to have been discussed in an MDT 
meeting. Overall, 51 trusts (approximately 35%) did not achieve this standard. 

Pathological confirmation rates below 75% should be reviewed to determine whether best practice is being followed and whether patients have access to the whole range of biopsy techniques. ALIGNS TO NICE QS7 

Nationally, 69% of cases submitted were recorded to have a pathological 
confirmation of their cancer. Overall, 102 trusts (approximately 70%) did not achieve 
this standard. 

Non-small-cell lung cancer, not otherwise specified (NSCLC NOS) rates of more than 20% should be reviewed to ensure that best practice pathological diagnostic techniques including immunohistochemistry are being followed, in order that patients receive appropriate chemotherapy regimens. ALIGNS TO NICE QS7 

RECOMMENDATION 
Nationally, 12% of NSCLC cases submitted were recorded to have a SNOMED code of 
M8046/3 (NSCLC NOS). Overall, 22 trusts (approximately 15%) did not achieve this 
standard. 

At least 80% of patients are seen by a lung cancer nurse specialist (LCNS); at least 80% of patients should have an LCNS present at the time of diagnosis (note that these data are not available for Wales). ALIGNS TO NICE QS4 

Nationally, 78% of patients were recorded to have seen a specialist nurse, although 
data were missing in 13% of cases, so the true proportion may be higher. Overall, 51 trusts (approximately 35%) did not achieve this standard. We were unable to analyse 
the proportion having an LCNS present at diagnosis. 

For patients undergoing bronchoscopy, at least 95% should have a CT scan prior to the procedure. ALIGNS TO NICE QS6 

Data collected in this transition year do not allow the analysis of this measure. 

Surgical resection rates for NSCLC below the England and Wales average of 16% should be reviewed. Furthermore, for early-stage disease, rates below 52% should be reviewed to ensure that patients on the margins of operability/resectability are being offered access to specialist thoracic surgical expertise (including second opinions). ALIGNS TO NICE QS8 

Nationally, 15.4% of patients with NSCLC were recorded to have had a surgical operation. Overall, 77 trusts (approximately 50%) did not achieve this standard. For patients with early-stage disease, 43% were recorded to have had surgery. 

Active anticancer treatment rates below the England and Wales average of 60% should be reviewed. ALIGNS TO NICE QS8–13 

Nationally, 58% of patients were recorded to have had anticancer treatment (surgery, chemotherapy or radiotherapy). Overall, 77 trusts (approximately 50%) did not achieve this standard. Chemotherapy rates for small-cell lung cancer below the England and Wales average of 70% should be reviewed. ALIGNS TO NICE QS13 

Nationally, 68% of patients with SCLC were recorded to have had chemotherapy. 

Overall, 62 trusts (approximately 40%) did not achieve this standard. 

Chemotherapy rates for good PS (0–1) stage IIIB/IV NSCLC below the England and Wales average of 60% should be reviewed. ALIGNS TO NICE QS12 

Nationally, 58% of patients with good PS and stage IIIB/IV NSCLC were recorded to have had chemotherapy. Overall, 76 trusts (approximately 50%) did not achieve this standard. 

## Standards Of Care For Individual Organisations

Data on key process and outcome measures ('headline indicators') relating to the care of patients with lung cancer in England, Wales and Guernsey are given in Table 1 by country, by SCN and by trust (key to codes is given in Appendix 1). These indicators have been chosen to benchmark against the recommendations made in the 2014 annual report, to align to national standards and guidelines, and to reflect the overall standard of care provided to patients. Similar data for Scotland are shown in Table 2. 

## Interpretation Of The Data

In interpreting these figures, the population coverage and data field completeness must be considered and can be cross-referenced using the online data tables. Furthermore, some of the results as presented do not take into account the casemix of patients (for example, some organisations might legitimately claim that lower treatment rates reflect an older population, or patients presenting with more advanced disease) - where available, these unadjusted proportions should be evaluated alongside casemixadjusted results. 

For unadjusted proportions, we present a colour coding in the tables to reflect performance by organisations compared with the targets set in the 2014 annual report (2013 data) and local action plan. 

For Scotland, performance against national quality improvement standards is shown. 

For casemix-adjusted data, we present an odds ratio (OR) and colour code the result based on its statistical significance. The confidence intervals for these will be available in the online reports. 

The OR refers to the chance of a particular treatment or outcome happening after adjusting for casemix, including performance status, stage and age, when compared with the national average.  
For example, if your organisation has a resection rate of 16% with an OR of 0.64 (less than 1), this suggests that your resection rate is lower than would be expected once the casemix of your patients has been taken into account. The colour coding will indicate whether this is statistically significant or likely to be a chance finding. 

It is recommended that organisations perform local deep-dive audits into areas of lower performance to try to understand the reasons for this. 

## Understanding Variation

It is clear from these tables that there is considerable variation across organisations in the outputs measured by the audit (notwithstanding earlier comments regarding casemix adjustment of the data). 

This is apparent both at SCN and even more markedly at hospital level. In the latter case, some of the more extreme variation is explained by low numbers of cases or low-quality data, so a useful way of reporting the variation is the interquartile range (IQR), describing the range of values in the middle 50%. These data are supplied at the bottom of each table. 

NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
Whole network 
1,456 
92.9  
74.0  
16.4  
63.2  
R1K99 London North West Healthcare NHS Trust (not Ealing) 
113 
77.0  
60.2  
7.8  
56.6  
RAS The Hillingdon Hospitals NHS FT 
109 
97.2  
16.5  
6.7  
88.1  
RAX Kingston Hospital NHS Trust 
91 
92.3  
84.6  
9.2  
82.4  
RFW West Middlesex University Hospital NHS Trust 
92 
90.2  
71.7  
21.4  
33.7  
RJ1 Guy's and St Thomas' NHS FT 
149 
100.0  
95.3  
11.5  
54.4  
RJ2 Lewisham Healthcare NHS Trust 
297 
99.3  
65.7  
36.3  
56.2  
RJ7 St George's Healthcare NHS Trust 
127 
59.1  
85.0  
11.7  
52.8  
RJZ King's College Hospital NHS FT 
137 
100.0  
97.1  
10.2  
51.1  
RPY The Royal Marsden NHS FT* 
13 
61.5  
61.5  
0.0  
92.3  
RQM Chelsea and Westminster Hospital NHS FT 
60 
100.0  
85.0  
21.7  
83.3  
RYJ Imperial College Healthcare NHS Trust 
268 
100.0  
79.1  
11.9  
77.2  
Whole network 
1,350 
92.9  
67.6  
11.6  
73.9  
LLCU Liverpool Lung Cancer Centre 
376 
93.1  
78.2  
8.5  
95.7  
RBL Wirral University Teaching Hospital NHS FT 
304 
98.0  
60.5  
8.8  
90.5  
REM Aintree University Hospital NHS FT 
322 
92.5  
71.1  
15.8  
64.6  
RVY Southport and Ormskirk Hospital NHS Trust 
141 
89.4  
56.7  
12.1  
79.4  
RWW Warrington and Halton Hospitals NHS FT 
200 
91.0  
59.0  
15.4  
21.5  
Whole network 
3,604 
89.7  
69.7  
9.9  
75.7  
RBT Mid Cheshire Hospitals NHS FT 
177 
94.4  
64.4  
17.0  
92.1  
RJN East Cheshire NHS Trust 
118 
94.9  
74.6  
5.5  
92.4  
REN The Clatterbridge Cancer Centre NHS FT* 
7 
0.0  
100.0  
20.0  
0.0  
RBV The Christie NHS FT* 
159 
0.0  
63.5  
0.0  
0.0  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N51 Greater Manchester, Lancashire and South Cumbria 
N50 Cheshire and Merseyside 
N44 London Cancer Alliance 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
RM2 University Hospital of South Manchester NHS FT* 
212 
99.5  
84.0  
4.5  
63.7  
RM3 Salford Royal NHS FT 
194 
96.4  
72.2  
12.7  
82.5  
RMC Bolton NHS FT 
194 
91.8  
60.3  
5.3  
86.1  
RMP Tameside Hospital NHS FT 
165 
89.1  
70.3  
11.8  
81.2  
RRF Wrightington, Wigan and Leigh NHS FT 
219 
95.0  
72.6  
6.8  
87.7  
RTX University Hospitals of Morecambe Bay NHS FT 
250 
88.8  
50.8  
13.7  
16.8  
RW3 Central Manchester University Hospitals NHS FT 
221 
93.2  
78.3  
13.8  
88.7  
RW6 Pennine Acute Hospitals NHS Trust 
618 
97.9  
70.7  
16.6  
92.4  
RWJ Stockport NHS FT 
199 
89.9  
82.9  
7.8  
78.9  
RXL Blackpool Teaching Hospitals NHS FT 
254 
91.3  
72.0  
6.4  
66.1  
RXN Lancashire Teaching Hospitals NHS FT 
288 
88.5  
66.3  
3.2  
88.9  
RXR East Lancashire Hospitals NHS Trust 
336 
96.7  
66.1  
11.4  
83.3  
Whole network 
2,246 
92.7  
65.1  
15.8  
85.0  
RLN City Hospitals Sunderland NHS FT 
290 
97.2  
68.3  
16.9  
90.3  
RNL North Cumbria University Hospitals NHS Trust 
238 
96.6  
70.6  
13.8  
90.3  
RR7 Gateshead Health NHS FT 
240 
92.1  
60.8  
18.2  
86.7  
RTD The Newcastle Upon Tyne Hospitals NHS FT 
326 
87.7  
47.5  
11.2  
75.2  
RTF Northumbria Healthcare NHS FT 
374 
84.2  
68.7  
23.8  
76.2  
RVW North Tees and Hartlepool NHS FT 
323 
94.4  
64.7  
17.1  
94.7  
RXP County Durham and Darlington NHS FT 
455 
97.1  
72.3  
9.7  
85.3  
Whole network 
4,122 
96.4  
71.5  
11.3  
83.6  
RAE Bradford Teaching Hospital NHS FT 
228 
98.7  
100.0  
4.0  
95.6  
RCB55 York Hospital (Historic RCB) 
188 
100.0  
71.8  
17.0  
97.3  
RCBCA Scarborough General Hospital (Historic RCC) 
131 
98.5  
67.2  
2.7  
93.9  
RCD Harrogate and District NHS FT 
117 
100.0  
67.5  
11.5  
87.2  
RCF Airedale NHS FT 
108 
99.1  
59.3  
28.3  
91.7  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N53 Yorkshire and the Humber 
N52 Northern England 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
RGM Papworth Hospital NHS FT* 
16 
100.0  
81.3  
0.0  
100.0  
RFF Barnsley Hospital NHS FT 
159 
99.4  
69.2  
30.2  
13.2  
RFR The Rotherham NHS FT 
194 
96.9  
68.6  
1.1  
94.8  
RFS Chesterfield Royal Hospital NHS FT 
212 
56.6  
57.1  
10.2  
83.0  
RHQ Sheffield Teaching Hospitals NHS FT 
446 
100.0  
69.7  
7.5  
79.6  
RJL Northern Lincolnshire and Goole Hospitals NHS FT 
328 
98.5  
57.0  
14.3  
90.5  
RP5 Doncaster and Bassetlaw Hospitals NHS FT 
347 
97.7  
63.4  
10.2  
71.8  
RR8 Leeds Teaching Hospitals NHS Trust 
500 
99.4  
79.0  
11.0  
86.6  
RWA Hull and East Yorkshire Hospitals NHS Trust 
397 
97.0  
61.7  
30.8  
83.9  
RWY Calderdale and Huddersfield NHS FT 
302 
95.0  
99.3  
9.4  
84.1  
RXF Mid Yorkshire Hospitals NHS Trust 
465 
100.0  
71.6  
2.1  
90.5  
Whole network 
3,023 
92.6  
67.8  
12.1  
72.2  
RC1 Bedford Hospital NHS Trust 
112 
98.2  
75.9  
19.1  
87.5  
RC9 Luton and Dunstable Hospital NHS FT 
129 
100.0  
58.1  
9.4  
79.8  
RCX The Queen Elizabeth Hospital, King's Lynn, NHS FT 
117 
100.0  
58.1  
19.0  
89.7  
RDD Basildon and Thurrock University Hospitals NHS FT 
212 
89.2  
60.8  
7.1  
78.3  
RDE Colchester Hospital University NHS FT 
232 
85.3  
37.9  
21.9  
47.8  
RGN Peterborough and Stamford Hospitals NHS FT 
171 
100.0  
80.7  
23.5  
92.4  
RGP James Paget University Hospitals NHS FT 
181 
88.4  
71.3  
9.4  
82.3  
RGQ Ipswich Hospital NHS Trust 
190 
94.2  
78.9  
10.8  
84.2  
RGR West Suffolk NHS FT 
137 
100.0  
65.0  
18.3  
90.5  
RGT Cambridge University Hospitals NHS FT 
186 
100.0  
84.9  
5.9  
97.3  
RM1 Norfolk and Norwich University Hospitals NHS FT 
385 
81.8  
58.7  
9.4  
72.7  
RQ8 Mid Essex Hospital Services NHS Trust 
195 
95.4  
75.4  
11.2  
48.2  
RQQ Hinchingbrooke Health Care NHS Trust 
79 
92.4  
68.4  
11.1  
13.9  
RWG West Hertfordshire Hospitals NHS Trust 
229 
98.7  
72.9  
6.0  
98.3  
RWH East and North Hertfordshire NHS Trust 
219 
91.3  
70.8  
17.1  
92.2  
RAJ Southend University Hospital NHS FT 
233 
88.8  
76.4  
10.5  
0.4  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N54 East of England 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
Whole network 
2,038 
94.1  
66.7  
11.3  
81.0  
RJF Burton Hospitals NHS FT 
147 
100.0  
70.1  
16.1  
93.9  
RK5 Sherwood Forest Hospitals NHS FT 
258 
95.0  
75.6  
15.1  
95.0  
RNQ Kettering General Hospital NHS FT 
195 
96.9  
68.7  
12.3  
90.8  
RNS Northampton General Hospital NHS Trust 
174 
97.7  
51.7  
13.2  
90.2  
RTG Derby Hospitals NHS FT 
385 
84.9  
69.4  
5.4  
82.9  
RWE University Hospitals of Leicester NHS Trust 
460 
95.7  
54.3  
15.6  
58.5  
RX1 Nottingham University Hospitals NHS Trust 
419 
95.2  
76.4  
8.1  
82.3  
Whole network 
2,367 
95.0  
67.4  
12.6  
84.8  
RJC South Warwickshire NHS FT 
118 
97.5  
72.9  
21.5  
83.1  
RJE University Hospital of North Staffordshire NHS Trust 
455 
92.1  
73.6  
12.8  
86.8  
RKB University Hospitals Coventry and Warwickshire NHS Trust 
292 
99.3  
71.9  
10.0  
90.8  
RL4 The Royal Wolverhampton NHS Trust 
211 
97.2  
63.0  
10.7  
96.2  
RLQ Wye Valley NHS Trust 
101 
95.0  
65.3  
8.5  
74.3  
RNA The Dudley Group NHS FT 
209 
84.2  
56.9  
6.6  
93.3  
RR1 Heart of England NHS FT 
405 
95.1  
65.4  
9.6  
92.6  
RRK University Hospitals Birmingham NHS FT 
215 
99.5  
63.3  
9.4  
93.5  
RXK Sandwell and West Birmingham Hospitals NHS Trust 
242 
97.5  
65.3  
30.0  
82.2  
Whole network 
2,348 
95.9  
66.7  
9.1  
82.8  
RA3 Weston Area Health NHS Trust 
95 
89.5  
70.5  
5.7  
66.3  
RA4 Yeovil District Hospital NHS FT 
82 
96.3  
54.9  
22.9  
82.9  
RA7 University Hospitals Bristol NHS FT 
148 
97.3  
65.5  
17.9  
95.3  
RA9 South Devon Healthcare NHS FT 
178 
97.2  
62.9  
0.0  
75.8  
RBA Taunton and Somerset NHS FT 
198 
91.9  
62.6  
5.9  
82.8  
RBK Walsall Healthcare NHS Trust 
119 
95.0  
73.1  
5.6  
0.8  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N56 West Midlands 
N55 East Midlands 
N57 South West 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
RBZ Northern Devon Healthcare NHS Trust 
127 
89.8  
56.7  
23.0  
89.8  
RD1 Royal United Hospital Bath NHS Trust 
224 
96.0  
47.8  
5.8  
87.9  
REF Royal Cornwall Hospitals NHS Trust 
232 
95.7  
82.8  
5.4  
94.8  
RH8 Royal Devon and Exeter NHS FT 
204 
98.5  
77.5  
2.2  
98.0  
RK9 Plymouth Hospitals NHS Trust 
305 
98.0  
54.8  
20.3  
79.0  
RTE Gloucestershire Hospitals NHS FT 
302 
96.0  
84.8  
5.5  
84.1  
RVJ North Bristol NHS Trust 
253 
97.6  
66.4  
12.0  
58.5  
Whole network 
2,304 
94.6  
67.0  
11.4  
70.6  
RA2 Royal Surrey County Hospital NHS Trust 
73 
78.1  
57.5  
15.2  
64.4  
RDU Frimley Park Hospital NHS FT 
161 
98.1  
62.1  
11.0  
68.3  
RN7 Dartford and Gravesham NHS Trust 
158 
98.1  
90.5  
5.6  
94.9  
RPA Medway NHS FT 
246 
100.0  
64.2  
5.7  
94.7  
RTK Ashford and St Peter's Hospitals NHS FT 
133 
91.0  
63.9  
1.4  
54.1  
RVV East Kent Hospitals University NHS FT 
447 
89.3  
62.2  
13.9  
25.5  
RWF Maidstone and Tunbridge Wells NHS Trust 
241 
95.0  
81.3  
12.2  
83.4  
RXC East Sussex Healthcare NHS Trust 
283 
94.3  
61.5  
16.0  
73.1  
RXH Brighton and Sussex University Hospitals NHS Trust 
244 
99.6  
66.0  
16.2  
87.3  
RYR16 Western Sussex Hospitals NHS Trust (RYR16) 
147 
98.6  
71.4  
8.6  
94.6  
RYR18 Western Sussex Hospitals NHS Trust (RYR18) 
171 
93.0  
59.6  
12.8  
82.5  
Whole network 
889 
89.5  
78.9  
22.5  
79.6  
RD8 Milton Keynes Hospital NHS FT 
64 
95.3  
84.4  
16.7  
89.1  
RHW Royal Berkshire NHS FT 
168 
99.4  
79.8  
14.4  
90.5  
RN3 Great Western Hospitals NHS FT 
193 
99.0  
75.1  
21.9  
90.7  
RTH Oxford University Hospitals NHS Trust 
305 
96.1  
76.1  
20.9  
63.3  
RXQ Buckinghamshire Healthcare NHS Trust 
159 
52.8  
85.5  
36.2  
82.4  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N58 South East Coast 
N59 Thames Valley 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
7A2AJ Bronglais General Hospital 
46 
100.0  
67.4  37.0  39.1  
7A3B7 Princess of Wales Hospital 
104 
100.0  
52.9  20.5  76.0  
Whole network 
1,433 
93.1  
72.1  
15.7  
62.4  
R1F Isle of Wight NHS Trust 
102 
98.0  
85.3  
27.6  
95.1  
RBD Dorset County Hospital NHS FT 
99 
93.9  
58.6  
18.2  
83.8  
RD3 Poole Hospital NHS FT 
126 
94.4  
66.7  
6.7  
77.8  
RDZ Royal Bournemouth and Christchurch Hospitals NHS FT 
201 
96.0  
51.7  
16.5  
82.1  
RHU Portsmouth Hospitals NHS Trust 
317 
97.5  
82.3  
19.0  
70.7  
RN506 Hampshire Hospitals NHS FT (RN5) 
100 
95.0  
54.0  
16.2  
82.0  
RN541 Hampshire Hospitals NHS FT (RN1) 
84 
96.4  
73.8  
22.6  
83.3  
RNZ Salisbury NHS FT 
92 
100.0  
73.9  
5.2  
79.3  
Whole network 
815 
96.2  
68.8  
10.5  
82.0  
R1HKH Barts Health NHS Trust (Whipps Cross) 
131 
98.5  
70.2  
11.8  
69.5  
R1HM0 Barts Health NHS Trust (St Barts) 
132 
99.2  
75.8  
7.1  
83.3  
R1HNH Barts Health NHS Trust (Newham) 
75 
94.7  
53.3  
2.8  
64.0  
RAL Royal Free London NHS FT 
113 
94.7  
42.5  
0.0  
93.8  
RF4 Barking, Havering and Redbridge University Hospitals NHS Trust 
89 
80.9  
64.0  
12.5  
78.7  
RQW The Princess Alexandra Hospital NHS Trust 
188 
100.0  
83.5  
10.2  
91.5  
RQX Homerton University Hospital NHS FT 
87 
98.9  
77.0  
24.6  
81.6  
Whole network 
1,499 
99.5  
72.4  
9.2  
85.7  
7A2AL Prince Philip Hospital 
166 
100.0  
87.3  
4.1  
95.8  
7A2BL Withybush General Hospital 
82 
100.0  
78.0  
9.1  
81.7  
7A3C7 Morriston Hospital 
244 
100.0  
73.8  
7.6  
89.8  
7A4C1 University Hospital Llandough 
262 
100.0  
69.8  
6.5  
88.9  
7A5B1 The Royal Glamorgan Hospital 
121 
99.2  
71.9  
11.5  87.6  
RHM University Hospital Southampton NHS FT 
312 
80.8  
81.7  
11.5  
0.6  
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
N95 South Wales Regional Cancer Network 
N61 London Cancer 
N60 Wessex 
NSCLC NOS rate (%) 
Patient seen by nurse 
specialist (%) 
*This is a tertiary trust that provides treatment for lung cancer patients, but where patients are not usually first seen. The cases may have been incorrectly allocated to this trust, and
instead first seen at another trust in the region. The data should be interpreted with caution. 
 equal to or exceeds level suggested in  NLCA annual report 2014 (2013 data) 
England total 
27,995 
93.6  
69.0  
12.4  
77.5  
Guernsey total 
39 
100.0  
71.8  
0.0  
46.2  
7A5B3 Prince Charles Hospital Site 
131 
100.0  
77.9  
4.8  
81.7  
7A6AM Nevill Hall Hospital 
100 
100.0  
79.0  
4.4  
99.0  
7A6AR Royal Gwent Hospital 
243 
97.5  
65.8  
14.0  81.1  
Whole Network 
493 
99.8  
74.2  
8.2  
95.1  
7A1A1 Ysbyty Glan Clwyd 
172 
100.0  
82.6  
9.8  
98.8  
7A1A4 Wrexham Maelor Hospital 
168 
99.4  
74.4  
6.2  
94.0  
7A1AU Ysbyty Gwynedd 
153 
100.0  
64.7  
8.2  
92.2  
Wales total 
1,992 
99.6  
72.9  
9.0  
88.0  
Max 
- 
100 100 
37 
100 
Min 
- 
90 65 
0 
46 
LQ 
- 
93 67 10 71 
Median 
- 
94 69 11 80 
UQ 
- 
96 72 14 84 
Max 
- 
100 
79 23 95 
LQ 
- 
92 62 
7 
74 
Median 
- 
97 70 11 83 
UQ 
- 
99 76 17 91 
Min 
- 
0 
17 
0 0 
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 
 below level suggested in NLCA annual report 2014 (2013 data) 
N96 North Wales Regional Cancer Network 
Range: network 
Range: trust 
NSCLC NOS rate (%) 
Patient seen by nurse 

*These figures and percentages represent totals from SCAN health boards: NHS Borders, NHS Dumfries and Galloway, NHS Fife; but do not include NHS Lothian.

NHS Lothian data are not available at this time owing to staffing issues within SCAN Audit and will be available in due course. Estimated case ascertainment for NHS Lothian based on 5-

specialist (%) 
Whole network* 
575* 
92.0% 83.0% 
8.3% 
84.5% 
Borders 
89 
97.7%  
86.0%  
8.9%  
91.0% 
Dumfries and Galloway 
153 
81.6%  
89.2%  
11.6%  
77.1% 
Fife 
333 
95.9%  
79.8%  
8.3%  
86.2% 
Whole network 
2631 
95.1%  
86.2%  
10.3%  
86.7% 
Ayrshire and Arran 
366 
93.5%  
88.6%  
8.8%  
91.0% 
Clyde 
438 
92.6%  
84.2%  
10.3%  
79.9% 
Forth Valley 
248 
95.5%  
91.2%  
12.5%  
98.4% 
Lanarkshire 
501 
95.2%  
91.5%  
10.0%  
87.8% 
North Glasgow 
658 
96.9% 82.6% 
10.6%  
84.3% 
South Glasgow 
420 
95.8%  
82.8%  
9.9%  
85.5% 
Whole network 
1,027 
90.9%  
89.8%  
9.7%  
77.8% 
Grampian 
425 
87.9%  
91.5%  
8.5%  
61.5% 
Highland 
204 
85.6%  
92.8%  
6.3%  
87.3% 
Western Isles 
19 
73.7%  
100%  
15.4%  
84.2% 
Tayside 
368 
98.6%  
86.0%  
12.7%  
94.0% 
Scotland total 
4,233* 
93.6%  
86.6%  
10.0%  
84.2% 
Shetland 
10 
80.0%  
100%  
12.5%  
100% 
Lothian 
- – - – - 
Orkney 
1 
Results suppressed owing to small numbers 
Place first seen 
Actual number 
Discussed at MDT (%) 
Pathological diagnosis 
(%) 

year average would be expected to be circa 730 total cases submitted, making SCAN's total closer to circa 1,300 patients, rather than 596 as shown above, and the Scotland total closer to circa 4,960. 

 equal to or exceeds level suggested in QPI 
 below level suggested in QPI 

chemotherapy 
SCLC patients 
(odds ratio) 
Whole network 
67.2  
1.49  
22.2  
1.77  
67.3  
1.46  
72.2  
1.39  
R1K99 London North West Healthcare NHS Trust (not Ealing) 
83.2  
4.01  
45.0  
4.84  
44.4  
0.58  
66.7  
2.15  
RAX Kingston Hospital NHS Trust 
56.0  
0.95  
2.5  
0.08  
62.5  
1.08  
80.0  
2.47  
RFW West Middlesex University Hospital NHS Trust 
72.8  
2.78  
23.2  
3.74  
66.7  
1.4  
80.0  
3.60  
RJ1 Guy's and St Thomas' NHS FT 
82.6  
2.66  
22.5  
0.90  
91.9  
8.9  
87.5  
3.50  
RJ2 Lewisham Healthcare NHS Trust 
69.7  
2.02  
40.7  
9.05  
53.7  
0.9  
51.9  
0.81  
RJ7 St George's Healthcare NHS Trust 
54.3  
0.73  
14.2  
0.64  
73.7  
2.8  
83.3  
2.27  
RJZ King's College Hospital NHS FT 
84.7  
2.81  
18.0  
1.18  
80.5  
3.0  
57.1  
0.48  
RQM Chelsea and Westminster Hospital NHS FT 
53.3  
1.08  
3.6  
0.33  
47.4  
0.7  
80.0  
1.01  
RYJ Imperial College Healthcare NHS Trust 
69.4  
1.46  
17.4  
0.98  
74.6  
2.0  
76.0  
1.21  
Whole network 
63.7  
1.34  
22.7  
1.76  
55.9  
0.88  
65.1  
0.70  
LLCU Liverpool Lung Cancer Centre 
72.9  
2.51  
24.5  
1.80  
57.7  
1.04  
70.9  
1.16  
RBL Wirral University Teaching Hospital NHS FT 
62.8  
1.51  
19.6  
1.76  
61.5  
1.15  
65.2  
0.86  
REM Aintree University Hospital NHS FT 
64.6  
1.14  
28.6  
2.30  
58.2  
0.99  
58.3  
0.37  
RVY Southport and Ormskirk Hospital NHS Trust 
51.1  
1.14  
11.0  
0.74  
53.8  
0.9  
58.3  
0.56  
RWW Warrington and Halton Hospitals NHS FT 
54.5  
0.56  
22.5  
1.66  
43.2  
0.5  
64.0  
0.55  
Whole network 
59.4  
1.16  
14.3  
0.84  
62.8  
1.25  
70.8  
1.31  
RBT Mid Cheshire Hospitals NHS FT 
63.8  
1.47  
19.1  
1.42  
54.5  
0.81  
68.4  
1.68  
RBV The Christie NHS FT* 
67.3  
1.80  
0.0  
54.5  
0.75  
73.7  
1.90  
having 
chemotherapy 
SCLC patients 
RAS The Hillingdon Hospitals NHS FT 
21.1  
0.19  
1.9  
0.15  
31.6  
0.28  
100.0  
RPY The Royal Marsden NHS FT* 
76.9  
1.63  
0.0  
42.9  
0.4  
100.0  
REN The Clatterbridge Cancer Centre NHS FT* 
85.7  
5.32  
40.0  
2.37  
100.0  
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
chemotherapy 
SCLC patients 
(odds ratio) 
RJN East Cheshire NHS Trust 
67.8  
2.14  
24.3  
2.12  
68.4  
1.8  
69.2  
1.30  
RM2 University Hospital of South Manchester NHS FT* 
73.1  
2.22  
22.9  
1.48  
62.2  
1.3  
81.8  
2.45  
RM3 Salford Royal NHS FT 
49.5  
0.82  
15.9  
1.23  
71.4  
1.3  
65.4  
1.13  
RMC Bolton NHS FT 
54.6  
1.23  
13.3  
0.94  
62.1  
1.1  
60.0  
1.13  
RMP Tameside Hospital NHS FT 
59.4  
1.62  
14.1  
1.12  
71.4  
1.8  
71.4  
2.59  
RRF Wrightington, Wigan and Leigh NHS FT 
58.0  
1.06  
21.8  
1.60  
72.2  
1.6  
55.3  
0.58  
RTX University Hospitals of Morecambe Bay NHS FT 
45.2  
0.52  
1.8  
0.07  
62.0  
1.2  
90.9  
3.52  
RW3 Central Manchester University Hospitals NHS FT 
63.8  
1.26  
15.5  
0.89  
40.5  
0.5  
62.1  
0.83  
RW6 Pennine Acute Hospitals NHS Trust 
58.4  
1.14  
18.3  
1.37  
50.6  
0.8  
70.1  
1.23  
RWJ Stockport NHS FT 
71.4  
1.76  
24.6  
1.70  
61.3  
1.2  
82.6 
1.90  
RXL Blackpool Teaching Hospitals NHS FT 
63.4  
1.35  
14.5  
0.94  
79.2  
3.4  
63.0  
0.84  
RXN Lancashire Teaching Hospitals NHS FT 
48.6  
0.64  
2.0  
0.06  
65.3  
1.4  
85.3  
3.35  
RXR East Lancashire Hospitals NHS Trust 
59.8  
1.07  
11.1  
0.67  
73.3  
2.0  
71.4  
0.75  
Whole network 
61.6  
1.35  
14.0  
1.02  
67.4  
1.56  
73.7  
1.40  
RLN City Hospitals Sunderland NHS FT 
64.5  
1.59  
15.4  
1.50  
66.7  
1.7  
76.7  
1.26  
RNL North Cumbria University Hospitals NHS Trust 
59.2  
1.11  
17.3  
1.65  
65.4  
1.7  
64.3  
0.89  
RR7 Gateshead Health NHS FT 
46.7  
0.84  
10.7  
0.82  
51.5  
0.7  
60.9  
0.96  
RTD The Newcastle Upon Tyne Hospitals NHS FT 
61.3  
1.36  
11.4  
0.82  
85.3  
4.2  
77.8  
1.58  
RTF Northumbria Healthcare NHS FT 
60.4  
1.39  
13.6  
0.98  
73.0  
2.3  
73.2  
1.71  
RVW North Tees and Hartlepool NHS FT 
65.9  
1.48  
11.7  
0.55  
57.6  
0.9  
84.8  
3.59  
RXP County Durham and Darlington NHS FT 
66.8  
1.60  
17.4  
1.29  
64.5  
1.3  
73.1  
1.24  
Whole network 
47.1  
0.55  
12.4  
0.68  
49.6  
0.69  
57.9  
0.53  
RAE Bradford Teaching Hospital NHS FT 
69.7  
1.32  
16.7  
0.85  
63.6  
1.24  
80.0  
1.09  
RCB55 York Hospital (Historic RCB) 
61.7  
1.14  
19.5  
1.14  
60.7  
1.23  
70.4  
1.03  
RCBCA Scarborough General Hospital (Historic RCC) 
57.3  
1.04  
12.6  
0.76  
36.4  
0.39  
83.3  
2.14  
having 
chemotherapy 
SCLC patients 
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N53 Yorkshire and the Humber 
N52 Northern England 
chemotherapy 
SCLC patients 
(odds ratio) 
RCD Harrogate and District NHS FT 
60.7  
2.04  
15.2  
1.26  
90.0  
10.70  
72.2  
2.10  
RCF Airedale NHS FT 
57.4  
1.10  
13.1  
0.81  
50.0  
0.82  
77.8  
1.40  
RFF Barnsley Hospital NHS FT 
61.6  
1.57  
12.1  
1.00  
69.0  
1.6  
84.2  
3.39  
RFR The Rotherham NHS FT 
9.3  
0.04  
2.6  
0.10  
4.0  
0.0  
17.5  
0.08  
RFS Chesterfield Royal Hospital NHS FT 
42.0  
0.44  
7.4  
0.43  
55.8  
1.0  
85.7  
1.24  
RJL Northern Lincolnshire and Goole Hospitals NHS FT 
57.6  
0.82  
16.7  
0.89  
60.7  
1.2  
72.1  
0.81  
RR8 Leeds Teaching Hospitals NHS Trust 
73.0  
3.09  
21.1  
1.37  
82.5  
3.2  
65.5  
1.14  
RWA Hull and East Yorkshire Hospitals NHS Trust 
61.7  
1.13  
13.5  
0.92  
56.8  
1.0  
71.4  
1.03  
RWY Calderdale and Huddersfield NHS FT 
59.9  
1.06  
16.7  
1.39  
52.8  
0.9  
85.0  
1.76  
RXF Mid Yorkshire Hospitals NHS Trust 
58.5  
1.04  
18.3  
1.66  
66.3  
1.4  
71.4  
1.30  
Whole network 
60.8  
1.16  
14.0  
0.82  
57.5  
1.01  
66.6  
1.01  
RC1 Bedford Hospital NHS Trust 
64.3  
1.07  
23.2  
1.29  
44.0  
0.56  
40.0  
0.30  
RC9 Luton and Dunstable Hospital NHS FT 
34.1  
0.28  
3.4  
0.12  
48.0  
0.64  
63.6  
0.62  
RCX The Queen Elizabeth Hospital, King's Lynn, NHS FT 
46.2  
0.48  
11.2  
0.65  
41.2  
0.61  
77.8  
0.81  
RDD Basildon and Thurrock University Hospitals NHS FT 
51.4  
0.66  
18.7  
1.18  
62.2  
1.30  
52.0  
0.59  
RDE Colchester Hospital University NHS FT 
77.2  
3.11  
13.5  
0.84  
51.6  
0.79  
69.6  
1.34  
RGN Peterborough and Stamford Hospitals NHS FT 
69.0  
1.69  
19.1  
1.41  
51.3  
0.7  
72.2  
0.87  
RGP James Paget University Hospitals NHS FT 
53.0  
0.70  
3.6  
0.11  
61.9  
1.3  
83.3  
3.85  
RGQ Ipswich Hospital NHS Trust 
74.7  
3.57  
8.8  
1.22  
76.7  
2.4  
74.1  
2.14  
RGR West Suffolk NHS FT 
48.9  
0.56  
16.7  
1.32  
50.0  
0.7  
82.4  
1.71  
RGT Cambridge University Hospitals NHS FT 
66.7  
1.42  
26.2  
1.86  
73.9  
2.3  
78.6  
2.29  
RM1 Norfolk and Norwich University Hospitals NHS FT 
68.3  
1.28  
12.1  
0.46  
61.3  
1.2  
77.8  
1.31  
RQ8 Mid Essex Hospital Services NHS Trust 
65.6  
1.79  
13.9  
0.93  
51.4  
0.8  
47.4  
0.56  
having 
RAJ Southend University Hospital NHS FT 
58.4  
1.31  
12.1  
0.94  
57.8  
0.84  
52.4  
0.7  
chemotherapy 
SCLC patients 
RGM Papworth Hospital NHS FT* 
81.3  
3.00  
57.1  
4.41  
0.0  
100.0  
having 
RHQ Sheffield Teaching Hospitals NHS FT 
0.0  
0.0  
0.0  0.0  
RP5 Doncaster and Bassetlaw Hospitals NHS FT 
0.6  
0.00  
0.0  
1.4  
0.0  
0.0  
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N54 East of England 
chemotherapy 
SCLC patients 
(odds ratio) 
RQQ Hinchingbrooke Health Care NHS Trust 
69.6  
1.76  
15.7  
0.96  
63.2  
1.8  
88.9  
5.32  
RWG West Hertfordshire Hospitals NHS Trust 
48.9  
0.78  
9.4  
0.69  
42.9  
0.5  
47.1  
0.36  
RWH East and North Hertfordshire NHS Trust 
58.0  
1.10  
18.0  
1.44  
63.8  
1.3  
68.2  
1.35  
Whole network 
55.8  
0.95  
15.9  
1.08  
53.3  
0.85  
70.2  
1.44  
RJF Burton Hospitals NHS FT 
51.7  
0.68 
19.1  
1.26 
63.0  
1.4  
73.3  
0.97  
RK5 Sherwood Forest Hospitals NHS FT 
46.1  
0.62  
14.8  
1.16  
39.6  
0.5  
72.3  
2.34  
RNQ Kettering General Hospital NHS FT 
52.3  
0.92  
16.5  
0.99  
80.0  
2.5  
52.6  
0.83  
RNS Northampton General Hospital NHS Trust 
58.0  
1.47  
14.5  
1.69  
56.7  
0.8  
56.3  
0.79  
RTG Derby Hospitals NHS FT 
53.0  
0.63  
22.5  
1.74  
47.8  
0.7  
75.0  
1.43  
RWE University Hospitals of Leicester NHS Trust 
56.7  
1.19  
10.2  
0.64  
51.3  
0.8  
64.7  
1.14  
RX1 Nottingham University Hospitals NHS Trust 
65.6  
1.36  
16.2  
0.90  
55.8  
1.0  
78.7  
1.91  
Whole network 
55.3  
0.98  
15.4  
1.23  
62.6  
1.18  
72.9  
1.36  
RBK Walsall Healthcare NHS Trust 
49.6  
0.64  
5.8  
0.23  
66.7  
1.35  
66.7  
0.91  
RJC South Warwickshire NHS FT 
55.1  
1.19  
16.8  
0.64  
66.7  
2.5  
70.6  
2.11  
RJE University Hospital of North Staffordshire NHS Trust 
61.3  
1.21  
24.1  
2.72  
71.2  
1.9  
70.4  
1.26  
RKB University Hospitals Coventry and Warwickshire NHS Trust 
61.3  
1.40  
14.3  
1.35  
54.5  
0.7  
83.9  
2.05  
RL4 The Royal Wolverhampton NHS Trust 
51.7  
0.81  
13.2  
1.16  
44.4  
0.6  
74.1  
1.27  
RLQ Wye Valley NHS Trust 
55.4  
0.97  
9.6  
0.64  
52.2  
0.7  
42.9  
0.21  
RNA The Dudley Group NHS FT 
55.5  
0.94  
12.1  
1.01  
73.2  
2.1  
64.0  
0.83  
RR1 Heart of England NHS FT 
44.2  
0.60  
15.1  
1.47  
59.1  
1.1  
77.3  
1.85  
RRK University Hospitals Birmingham NHS FT 
58.6  
1.37  
13.3  
0.93  
75.7  
2.6  
66.7  
0.84  
RXK Sandwell and West Birmingham Hospitals NHS Trust 
57.9  
0.97  
15.4  
1.00  
62.5  
1.2  
82.1  
2.55  
having 
chemotherapy 
SCLC patients 
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N56 West Midlands 
N55 East Midlands 
chemotherapy 
SCLC patients 
(odds ratio) 
Whole network 
64.1  
1.32  
17.4  
1.17 
61.0  
1.27  
73.0  
1.27  
RA3 Weston Area Health NHS Trust 
64.2  
1.37  
22.0  
1.68  
82.4  
3.11  
72.7  
1.17  
RA4 Yeovil District Hospital NHS FT 
57.3  
1.09  
17.8  
0.91  
75.0  
3.52  
85.7  
3.23  
RA7 University Hospitals Bristol NHS FT 
64.9  
1.39  
13.2  
0.98  
74.4  
2.22  
81.3  
2.19  
RA9 South Devon Healthcare NHS FT 
61.8  
1.25  
11.5  
0.66  
59.5  
1.26  
72.2  
1.28  
RBA Taunton and Somerset NHS FT 
68.2  
1.77  
20.5  
2.17  
78.7  
3.49  
81.8  
1.97  
RBZ Northern Devon Healthcare NHS Trust 
55.9  
0.95  
12.1  
0.67  
61.9  
1.20  
80.0  
2.48  
RD1 Royal United Hospital Bath NHS Trust 
63.4  
0.97  
18.7  
1.07  
51.0  
0.86  
75.0  
0.89  
REF Royal Cornwall Hospitals NHS Trust 
82.3  
5.94  
13.8  
1.01  
71.8  
1.48  
81.0  
2.96  
RH8 Royal Devon and Exeter NHS FT 
73.5  
2.22  
17.3  
1.16  
57.4  
1.4  
82.4  
2.17  
RK9 Plymouth Hospitals NHS Trust 
57.4  
0.92  
17.5  
0.99  
58.7  
1.1  
56.7  
0.53  
RTE Gloucestershire Hospitals NHS FT 
65.9  
1.28  
18.6  
1.34  
48.5  
0.7  
61.1  
0.58  
RVJ North Bristol NHS Trust 
51.0  
0.65  
22.6  
1.75  
52.9  
0.9  
68.8  
1.08  
Whole network 
50.3  
0.67  
9.8  
0.56  
48.1  
0.67  
59.6  
0.68  
RA2 Royal Surrey County Hospital NHS Trust 
47.9  
0.86  
6.3  
0.35  
55.6  
1.10  
25.0  
0.14  
RDU Frimley Park Hospital NHS FT 
52.2  
0.86  
19.6  
1.59  
68.0  
1.78  
60.0  
0.63  
RN7 Dartford and Gravesham NHS Trust 
68.4  
1.65  
13.6  
0.83  
56.8  
0.8  
64.7  
0.99  
RPA Medway NHS FT 
45.9  
0.70  
7.6  
0.57  
40.0  
0.4  
58.8  
0.85  
RTK Ashford and St Peter's Hospitals NHS FT 
31.6  
0.25  
6.0  
0.28  
16.7  
0.2  
56.3  
0.42  
RVV East Kent Hospitals University NHS FT 
41.2  
0.39  
0.5  
0.02  
30.8  
0.3  
45.8  
0.40  
RWF Maidstone and Tunbridge Wells NHS Trust 
66.0  
1.19  
16.9  
1.37  
55.9  
1.0  
62.2  
0.54  
RXC East Sussex Healthcare NHS Trust 
48.8  
0.73  
7.8  
0.44  
64.3  
1.7  
59.5  
0.69  
RXH Brighton and Sussex University Hospitals NHS Trust 
49.6  
0.89  
14.2  
1.42  
56.3  
0.9  
73.9  
2.85  
RYR16 Western Sussex Hospitals NHS Trust (RYR16) 
58.5  
0.68  
16.3  
0.88  
56.8  
1.0  
50.0  
0.42  
RYR18 Western Sussex Hospitals NHS Trust (RYR18) 
52.0  
0.54  
12.2  
0.75  
52.1  
0.75  
85.7  
1.80  
having 
chemotherapy 
SCLC patients 
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N58 South East Coast 
N57 South West 
chemotherapy 
SCLC patients 
(odds ratio) 
Whole network 
63.9  
1.26  
24.4  
1.99  
53.7  
0.91  
71.6  
1.28  
RD8 Milton Keynes Hospital NHS FT 
79.7  
1.63  
39.7  
2.38  
33.3  
0.25  
83.3  
0.84  
RHW Royal Berkshire NHS FT 
61.9  
1.27  
22.8  
2.75  
46.9  
0.6  
72.2  
1.65  
RN3 Great Western Hospitals NHS FT 
58.5  
1.01  
14.8  
1.23  
63.4  
1.3  
71.4  
1.07  
RTH Oxford University Hospitals NHS Trust 
64.9  
1.20  
28.1  
2.06  
53.2  
0.9  
78.3  
1.43  
RXQ Buckinghamshire Healthcare NHS Trust 
64.2  
1.64  
23.7  
1.84  
50.0  
1.0  
60.0  
1.30  
Whole network 
57.6  
0.78  
16.1  
0.88  
50.0  
0.77  
76.7  
1.16  
R1F Isle of Wight NHS Trust 
58.8  
1.13  
7.7  
0.55  
50.0  
0.96  
87.5  
4.92  
RBD Dorset County Hospital NHS FT 
66.7  
1.80  
11.8  
0.90  
71.4  
2.31  
58.3  
0.53  
RD3 Poole Hospital NHS FT 
62.7  
1.57  
11.1  
0.65  
57.1  
0.81  
66.7  
1.24  
RDZ Royal Bournemouth and Christchurch Hospitals NHS FT 
57.7  
0.81  
11.5  
0.51  
46.9  
0.75  
87.5  
3.12  
RHM University Hospital Southampton NHS FT 
47.8  
0.36  
23.3  
1.17  
48.5  
0.6  
67.9  
0.72  
RHU Portsmouth Hospitals NHS Trust 
59.0  
0.70  
17.5  
1.04  
41.2  
0.5  
73.2  
0.72  
RN506 Hampshire Hospitals NHS FT (RN5) 
58.0  
0.77  
7.2  
0.31  
61.1  
1.2  
82.4  
1.18  
RNZ Salisbury NHS FT 
65.2  
1.41  
26.8  
2.21  
52.6  
1.2  
90.0  
3.01  
Whole network 
57.8  
1.00  
16.6  
0.87  
57.9  
0.90  
63.6  
0.84  
R1HM0 Barts Health NHS Trust (St Barts) 
62.1  
1.28  
12.1  
0.60  
83.3  
4.21  
61.5  
1.09  
R1HNH Barts Health NHS Trust (Newham) 
50.7  
0.73  
4.2  
0.15  
50.0  
0.51  
25.0  
0.19  
RF4 Barking, Havering and Redbridge University Hospitals NHS Trust 
55.1  
0.89  
22.2  
0.88  
100.0  
71.4  
1.38  
RQW The Princess Alexandra Hospital NHS Trust 
60.1  
0.94  
30.2  
4.06  
32.4  
0.3  
57.1  
0.52  
RQX Homerton University Hospital NHS FT 
65.5  
1.47  
21.0  
1.83  
68.4  
1.3  
66.7  
0.55  
having 
chemotherapy 
SCLC patients 
RN541 Hampshire Hospitals NHS FT (RN1) 
59.5  
1.01  
16.0  
1.01  
53.3  
0.9  
100.0  
R1HKH Barts Health NHS Trust (Whipps Cross) 
62.6  
1.76  
18.5  
1.21  
71.4  
2.06  
100.0  
RAL Royal Free London NHS FT 
44.2  
0.46  
0.0  
68.8  
1.26  
100.0  
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N61 London Cancer 
N59 Thames Valley 
N60 Wessex 
chemotherapy 
SCLC patients 
(odds ratio) 
Whole network 
61.3  
1.41  
16.6  
1.39  
63.2  
1.25  
66.5  
1.10  
7A2AJ Bronglais General Hospital 
45.7 
0.93  
14.3  
3.32  
44.4  
0.59  
75.0  
1.74  
7A2AL Prince Philip Hospital 
68.7  
1.23  
20.8  
1.41  
64.2  
1.27  
61.1  
0.51  
7A2BL Withybush General Hospital 
64.6  
1.21  
26.0  
2.01  
68.4  
1.80  
87.5  
2.76  
7A3B7 Princess of Wales Hospital 
61.5  
1.58  
16.7  
1.54  
50.0  
0.67  
62.5  
0.57  
7A3C7 Morriston Hospital 
61.1  
1.36  
8.7  
0.74  
55.4  
0.95  
77.1  
1.97  
7A4C1 University Hospital Llandough 
57.3 
1.19  
17.1  
1.36  
66.7  
1.39  
75.0  
1.40  
7A5B1 The Royal Glamorgan Hospital 
57.9 
1.73  
19.6  
1.69  
72.7  
2.02  
33.3  
0.57  
7A5B3 Prince Charles Hospital Site 
67.9  
2.70  
15.2  
1.16  
54.5  
0.94  
52.6  
1.11  
7A6AM Nevill Hall Hospital 
68.0  
2.77  
18.0  
2.12  
85.7  
4.36  
81.8  
5.30  
7A6AR Royal Gwent Hospital 
58.0 
0.99  
16.7  
1.34  
73.0  
1.63  
57.6  
0.60  
Whole network 
58.4  
1.04  
13.0  
0.95  
55.9  
0.97  
70.6  
0.88  
7A1A4 Wrexham Maelor Hospital 
64.9  
1.43  
17.9  
1.70  
71.1  
1.89  
77.8  
1.33  
7A1AU Ysbyty Gwynedd 
50.3  
0.91  
13.7  
1.32  
68.0  
1.45  
76.9  
1.52  
having 
7A1A1 Ysbyty Glan Clwyd 
59.3  
0.86  
7.7  
0.36  
37.5  
0.49  
60.7  
0.5  
England total 
57.6  
- 
15.4  
- 
57.3  
- 
67.9  
- 
Wales total 
60.6  
- 
15.7  
- 
61.1  
- 
67.6  
- 
Guernsey total 
41.0  
- 
13.5  
- 
50.0  
- 
50.0  
- 
Min 
41 
- 
10 
- 
48 
- 
50 
- 
LQ 
56 
- 
14 
- 
52 
- 
64 
- 
Median 
59 
- 
16 
- 
57 
- 
70 
- 
UQ 
63 
- 
17 
- 
63 
- 
73 
- 
Max 
67 
- 
24 
- 
67 
- 
77 
- 
chemotherapy 
SCLC patients 
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
(odds ratio) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
(odds ratio) 
Anticancer 
treatment 
Place first seen 
Anticancer 
treatment 
(%) 
N95 South Wales Regional Cancer Network 
N96 North Wales Regional Cancer Network 
Range: network 
chemotherapy 
SCLC patients 
(odds ratio) 
having 
Min 
0 
- 
0 
- 
0 
- 
0 
- 
LQ 
53 
- 
12 
- 
50 
- 
61 
- 
Median 
59 
- 
15 
- 
58 
- 
72 
- 
UQ 
66 
- 
19 
- 
68 
- 
80 
- 
Max 
86 
- 
57 
- 
100 
- 
100 
- 
chemotherapy 
SCLC patients 
having 
(%) 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy 
 not statistically significantly different from national level 
(odds ratio) 
 statistically significantly better than national level 
 statistically significantly worse than national level 
NSCLC stage IIIB/IV 
and PS 0–1 having 
chemotherapy (%) 
(odds ratio) 
surgery 
having 
NSCLC 
surgery (%) 
NSCLC 
having 
*This is a tertiary trust that provides treatment for lung cancer patients, but where patients
are not usually first seen. The cases may have been incorrectly allocated to this trust, and 
instead first seen at another trust in the region. The data should be interpreted with 
caution. 
(odds ratio) 
Anticancer 
treatment 
 equal to or exceeds level suggested in  NLCA annual report 2014 (2013 data) 
Place first seen 
Anticancer 
treatment 
(%) 
Range: trust 
 below level suggested in NLCA annual report 2014 (2013 data) 
QPI 12b - Patients 
with SCLC not 
undergoing 
treatment with 
curative intent who 
receive palliative 
chemotherapy (%) 
SCAN 
20.7%  
56.2%  
45.9%  
54.5%  75.0%  37.6%  
60.8%  
56.8%  
Borders 
20.0%  
42.1%  
38.2%  
42.9%  
75.0%  46.3%  
60.0%  
20.0%  
18.8%  
53.3%  
39.2%  
50.0%  
100.0%  
39.2%  
50.0%  
69.2%  
Fife 
21.7%  
62.0%  
51.4%  
66.7%  
66.7%  
34.1%  
67.5%  
57.7%  
WoSCAN 
24.2%  
66.7%  
33.8%  
56.4%  
42.2%  
37.2%  
57.3%  
76.3%  
Ayrshire and 
Arran 
21.5%  
76.4%  
26.2%  
100%  
75.0%  43.7%  
65.2%  
84.4%  
Clyde 
20.9%  
60.4%  
27.9%  
54.5%  
40.0%  
27.0%  
40.7%  
62.5%  
Forth Valley 
29.2%  
75.0%  
27.8%  
100%  
37.5%  
44.0%  
60.0%  
81.8%  
Lanarkshire 
24.6%  
68.8%  
37.5%  
31.3%  
33.3%  
49.3%  
75.3%  
74.2%  
North Glasgow 
27.3%  
65.2%  
32.2%  
58.3%  
40.0%  
29.2%  
44.7%  
77.8%  
South Glasgow 
21.6%  
59.1%  
46.5%  
66.7%  
50.0%  
35.0%  
55.6%  
80.9%  
NoSCAN 
15.5%  
56.9%  
33.6%  
67.7%  70.0%  46.5%  
73.1%  
73.2%  
Grampian 
13.6%  
57.8%  
25.0%  
45.5%  
71.4%  41.1%  
64.8%  
55.3%  
Highland 
19.7%  
81.5%  
29.5%  
80.0%  
* 
43.9%  
75.0%  
85.7%  
Tayside 
15.2%  46.8%  
42.0%  
80.0%  77.8%  54.3%  
88.9%  
82.9%  
Shetland 
12.5%  
* * - – 
57.1% 
* - 
Western Isles 
15.4%  
* * - – 
27.3%  
* * 
QPI 11b - Patients 
with stage IIIB/IV 
NSCLC who receive 
double 
chemotherapy 
including platinum 
as their first-line 
regimen (%) 
QPI 11a - Patients 
with NSCLC not 
undergoing surgery 
who receive 
systemic anticancer 
therapy (%) 
Orkney 
*Results suppressed owing to small numbers
QPI 10 - Patients 
with limited-stage 
SCLC treated with 
radical intent who 
receive both 
chemotherapy and 
radiotherapy (%) 
QPI 9 - Patients 
with NSCLC not 
undergoing surgery 
who receive radical 
radiotherapy and 
concurrent or 
sequential 
chemotherapy (%) 
QPI 8 - Patients not 
undergoing surgery 
who receive 
radiotherapy with 
radical intent (%) 
QPI 6b - NSCLC 
stage I–II having 
surgery (%) 
Place first seen 
QPI 6a - NSCLC 
having surgery 
(%) 
Dumfries and 
Galloway 
Lothian 
QPI 12b - Patients 
with SCLC not 
undergoing 
treatment with 
curative intent who 
receive palliative 
chemotherapy (%) 
Scotland total 
21.7% 63.1% 
35.3% 
59.3% 
53.0% 
39.8% 61.8% 73.5% 
QPI 11b - Patients 
with stage IIIB/IV 
NSCLC who receive 
double 
chemotherapy 
including platinum 
as their first-line 
regimen (%) 
QPI 11a - Patients 
with NSCLC not 
undergoing surgery 
who receive 
systemic anticancer 
therapy (%) 
QPI 10 - Patients 
with limited-stage 
SCLC treated with 
radical intent who 
receive both 
chemotherapy and 
radiotherapy (%) 
QPI 9 - Patients 
with NSCLC not 
undergoing surgery 
who receive radical 
radiotherapy and 
concurrent or 
sequential 
chemotherapy (%) 
QPI 8 - Patients not 
undergoing surgery 
who receive 
radiotherapy with 
radical intent (%) 
QPI 6b - NSCLC 
stage I–II having 
surgery (%) 
 equal to or exceeds level suggested in QPI 
*Results suppressed owing to small numbers
Place first seen 
QPI 6a - NSCLC 
having surgery 
(%) 
 below level suggested in QPI 

## Lung Cancer Nurse Specialists

In 2014, access to LCNSs appears to have fallen. Of patients diagnosed in 2013, 84% were seen by an LCNS, but in the 2014 cohort, only 78% were seen. Nine organisations report that fewer than 25% of their patients see an LCNS, raising the possibility that data completeness may be an issue in these organisations. Similarly, only 87% of cases have a clear 'Yes' or 'No' as to whether the patient was seen, and it is likely that some of the remaining 13% of patients were in fact seen, suggesting that the overall figure of 78% may be an underestimate. 

As in previous years, we highlight the association between access to nurse specialists and receipt of anticancer treatment (Figure 10). For example, in 2014, 63.6% of those who saw an LCNS received anticancer treatment, compared with 24.6% of those who did not see a LCNS. 

|                   |   2014  |   2013  |   2012  |   2011  |   2010  |   2009  |   2008  |
|-------------------|---------|---------|---------|---------|---------|---------|---------|
| Seen by LCNS      |    63   |    65.6 |    66.6 |    65.3 |    64.4 |    64.8 |    59.4 |
| Not seen by LCNS  |    24.5 |    27.1 |    27.4 |    28.7 |    29.8 |    30.4 |    30.6 |
| Data not recorded |    48.2 |    35.4 |    39.7 |    44.8 |    44.8 |    52.6 |    51   |

The proportion of patients who should be seen by an LCNS continues to be a source of debate, with some feeling that the bar is set too high. As a result, the NLCFN carried out a survey of its members in 
2015, asking the question 'Is it feasible to have a new indicator in the NLCA that 90% of patients should be seen by a lung cancer specialist nurse?'. The responses were mixed, but 59% felt that it was feasible. 

Overwhelmingly, however, nurses felt that setting a challenging target was a good way to encourage investment in nursing expertise. 

should all be striving to meet this target as a minimum.' 

seen by an LCNS but realise this 
    is not feasible. However, by 
increasing the indicator level it 
   may be that this will help us 
           improve staffing and 
          strengthen our case.' 

patients should be seen by the 
LCNS but with the current level 
  of staff this is not possible 
unless more funding is agreed 
       for extra posts.' 

## Tertiary Trusts

Most activity relating to lung cancer initial diagnosis in England occurs in the secondary care trusts, which range from small district general hospitals to large teaching hospitals. Subsequent treatment often takes place in the same trust or, for some smaller trusts, the patient may be transferred to another secondary care organisation. Activity in these organisations is well represented by the audit, as the analysis of cases by 'place first seen' allocates patients to the decision-making MDT. 

However, there are several tertiary trusts (see table below) that do not provide diagnostic services and which are therefore the 'place first seen' only rarely. These trusts do provide a very important treatment service for patients in their local area, but also on a regional/national basis. In previous years, we have recorded the numbers of patients treated in these organisations, but in this transition year, we have not had access to the relevant activity data to allow this analysis. We hope to provide this in future rounds of the audit. 

| Trust code                                     |
|------------------------------------------------|
| RBV                                            |
|                                                |
| The Christie NHS FT                            |
|                                                |
| REN                                            |
|                                                |
| The Clatterbridge Cancer Centre NHS FT         |
|                                                |
| RGM                                            |
|                                                |
| Papworth Hospital NHS FT                       |
|                                                |
| RM2                                            |
|                                                |
| University Hospital of South Manchester NHS FT |
|                                                |
| RPY                                            |
|                                                |
| The Royal Marsden NHS FT                       |
|                                                |
| RT3                                            |
|                                                |
| Royal Brompton and Harefield NHS FT            |
|                                                |
RVY 
Southport and Ormskirk Hospital NHS Trust 
RWW 
Warrington and Halton Hospitals NHS FT 
RRF 
Wrightington, Wigan and Leigh NHS FT 
RW6 
Pennine Acute Hospitals NHS Trust 
RBT 
Mid Cheshire Hospitals NHS FT 
RMP 
Tameside Hospital NHS FT 
RJN 
East Cheshire NHS Trust 
RM3 
Salford Royal NHS FT 
RBV 
The Christie NHS FT 
Participated via COSD, but did not submit LUCADA data file, so not included in current analysis 
RMC 
Bolton NHS FT 
RF4 
Barking, Havering and Redbridge University Hospitals 
NHS Trust 
North Middlesex University Hospital NHS Trust 
RRV 
University College London Hospitals NHS FT 
RXP 
County Durham and Darlington NHS FT 
RXN 
Lancashire Teaching Hospitals NHS FT 
RXL 
Blackpool Teaching Hospitals NHS FT 
RAE 
Bradford Teaching Hospitals NHS FT 
RXR 
East Lancashire Hospitals NHS Trust 
RFS 
Chesterfield Royal Hospital NHS FT 
RVW 
North Tees and Hartlepool NHS FT 
RLN 
City Hospitals Sunderland NHS FT 
RTF 
Northumbria Healthcare NHS FT 
RCD 
Harrogate and District NHS FT 
RTR 
South Tees Hospitals NHS FT 
RCB55 
York Hospital (Historic RCB) 
N53 
Yorkshire and the Humber 
RR7 
Gateshead Health NHS FT 
RFF 
Barnsley Hospital NHS FT 
RFR 
The Rotherham NHS FT 
RE9 
South Tyneside NHS FT 
N52 
Northern England 
RWJ 
Stockport NHS FT 
RCF 
Airedale NHS FT 
RVR 
Epsom and St Helier University Hospitals NHS Trust 
North West London Hospitals NHS Trust (was RV8) 
RFW 
West Middlesex University Hospital NHS Trust 
RBN 
St Helens and Knowsley Hospitals NHS Trust 
University Hospital Llandough 
Withybush General Hospital 
Western Sussex Hospitals NHS Trust (RYR16) 
Western Sussex Hospitals NHS Trust (RYR18) 
Maidstone and Tunbridge Wells NHS Trust 
Surrey and Sussex Healthcare NHS Trust 
Ashford and St Peter's Hospitals NHS FT 
East Kent Hospitals University NHS FT 
Dartford and Gravesham NHS Trust 
East Sussex Healthcare NHS Trust 
Great Western Hospitals NHS FT 
Milton Keynes Hospital NHS FT 
Frimley Park Hospital NHS FT 
Royal Berkshire NHS FT 
Isle of Wight NHS Trust 
University Hospitals Coventry and Warwickshire NHS 
Sandwell and West Birmingham Hospitals NHS Trust 
Worcestershire Acute Hospitals NHS Trust (RWP01) 
University Hospital of North Midlands NHS Trust 
Shrewsbury and Telford Hospital NHS Trust 
Worcestershire Acute Hospitals NHS Trust 
(RWP31/50) 
University Hospitals Birmingham NHS FT 
Northern Devon Healthcare NHS Trust 
The Royal Wolverhampton NHS Trust 
Royal United Hospital Bath NHS Trust 
Royal Cornwall Hospitals NHS Trust 
University Hospitals Bristol NHS FT 
South Devon Healthcare NHS FT 
George Eliot Hospital NHS Trust 
Weston Area Health NHS Trust 
Taunton and Somerset NHS FT 
Yeovil District Hospital NHS FT 
The Dudley Group NHS FT 
Heart of England NHS FT 
Wye Valley NHS Trust 
Dorset County Hospital NHS FT 
Poole Hospital NHS FT 
Gloucestershire Hospitals NHS FT 
Royal Devon and Exeter NHS FT 
Plymouth Hospitals NHS Trust 

## Appendix 2: Glossary

| Adenocarcinoma                                                                              | a type of cancer arising from glandular tissue                                               |
|---------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------|
| Anticancer treatment                                                                        |                                                                                              |
| (active treatment)                                                                          |                                                                                              |
| a term used to define treatments for lung cancer that have an effect on the tumour          |                                                                                              |
| itself, not just on symptoms. In lung cancer patients, these are most often surgery,        |                                                                                              |
| chemotherapy, radiotherapy or a combination of these                                        |                                                                                              |
| Benchmark                                                                                   | a method of comparing processes and outcomes against standards                               |
| Biopsy                                                                                      | removal and examination of tissue, usually microscopic, to establish a precise               |
| (                                                                                           | pathological                                                                                 |
| Bronchoscopy                                                                                | a procedure for examining the airways by inserting an instrument (bronchoscope) into         |
| the trachea and lungs, normally via the nose. Enables a                                     | bronchial biopsy                                                                             |
| Bronchial biopsy                                                                            | removal of a small piece of lung tissue during a                                             |
| pathological                                                                                | diagnosis                                                                                    |
| Casemix                                                                                     | refers to the different characteristics of patients seen in different hospitals (for example |
| age, sex, disease stage, social deprivation and general health). Knowledge of differing     |                                                                                              |
| casemix enables a more accurate method of comparing quality of care (                       | casemix                                                                                      |
| adjustment                                                                                  | )                                                                                            |
| Casemix adjustment                                                                          | a statistical method of comparing quality of care between organisations that takes into      |
| account important and measurable patient characteristics                                    |                                                                                              |
| Chemotherapy                                                                                | medicines used in the treatment of cancer that can be given by mouth or by injection         |
| Comorbidity                                                                                 | medical condition(s) or disease process(es) that are additional to the disease under         |
| investigation (in this case, lung cancer). In the NLCA, this is recorded when a comorbidity |                                                                                              |
| restricts the type of treatment that can be given for lung cancer                           |                                                                                              |
| COSD                                                                                        | the Cancer Outcomes and Services Dataset (COSD) is the national standard for reporting       |
| on cancer in the NHS in England. Trusts submit a data file to the National Cancer           |                                                                                              |
| Registration Service (NCRS) every month                                                     |                                                                                              |
| CT scan                                                                                     | the abbreviated term for computerised tomography. These tests produce detailed               |
| images of the body using X-ray images that are enhanced by a computer                       |                                                                                              |
| Data completeness                                                                           | a measure of the standard of data submitted to the audit, in terms of both the number        |
| of cases submitted and the data on each individual case                                     |                                                                                              |
| Diagnosis                                                                                   | confirming the presence of the disease (see                                                  |
| Health board                                                                                | an organisation providing healthcare services in Scotland and Wales. A health board may      |
| manage one or several hospitals within a region                                             |                                                                                              |
| Hospital trust                                                                              | an organisation providing secondary healthcare services in England. A hospital trust may     |
| be made up of one or several hospitals within a region                                      |                                                                                              |
| Interquartile range                                                                         | the range of a particular variable excluding the highest quarter and lowest quarter of the   |
| values recorded. Can be useful to give a sense of the spread of a set of data without       |                                                                                              |
| being affected by very high or very low results                                             |                                                                                              |
| A nurse specialising in care of people diagnosed with lung cancer or mesothelioma           | Lung cancer nurse                                                                            |
| specialist (LCNS)                                                                           |                                                                                              |
| Lead clinician                                                                              | Healthcare professional in a hospital taking overall responsibility for the services         |
| provided for a specific disease area                                                        |                                                                                              |
| MDT                                                                                         | multidisciplinary team; a group of healthcare professionals working in a coordinated         |
| manner for patient care                                                                     |                                                                                              |
| Mesothelioma                                                                           | cancer of the lining of the lung caused by exposure to asbestos                             |
|----------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------|
| NLCA                                                                                   | National Lung Cancer Audit                                                                  |
| Non-small-cell lung                                                                    |                                                                                             |
| cancer (NSCLC)                                                                         |                                                                                             |
| a group of types of lung cancer sharing certain characteristics, which makes up 85–90% |                                                                                             |
| of all lung cancers. Includes squamous carcinoma and adenocarcinoma. See also          | small-                                                                                      |
| cell lung cancer                                                                       |                                                                                             |
| NOS                                                                                    | not otherwise specified. In the case of                                                     |
| diagnosis has not been subclassified to a particular cell type, eg squamous carcinoma, |                                                                                             |
| adenocarcinoma etc                                                                     |                                                                                             |
| Operability                                                                            | in the consideration of surgical treatment of a lung cancer, refers to patients' ability to |
| cope with both the operation and the subsequent reduction of lung volume and           |                                                                                             |
| function. See also                                                                     | resectability                                                                               |
| Pathological diagnosis                                                                 | refers to a diagnosis of cancer based on pathological examination of a tissue (histology)   |
| or fluid (cytology), as opposed to a diagnosis based on clinical assessment or non-    |                                                                                             |
| pathological investigation (eg                                                         | CT scan                                                                                     |
| Performance status (PS)                                                                | a systematic method of recording the ability of an individual to undertake the tasks of     |
| normal daily life compared with that of a healthy person                               |                                                                                             |
| Radiotherapy                                                                           | the treatment of cancer using radiation, which is most often delivered by X-ray beams       |
| (external beam radiotherapy) but can be given internally (brachytherapy)               |                                                                                             |
| Resectability                                                                          | in the consideration of surgical treatment of a lung cancer, refers to the ability of the   |
| surgeon to remove the tumour taking into account its location and stage. See also      |                                                                                             |
| operability                                                                            |                                                                                             |
| RCP                                                                                    | abbreviation for the Royal College of Physicians, the professional body of doctors          |
| practising general medicine and its subspecialties                                     |                                                                                             |
| Secondary care                                                                         | care provided by a hospital, as opposed to that provided in the community by a GP and       |
| allied staff (primary care)                                                            |                                                                                             |
| Small-cell lung cancer                                                                 |                                                                                             |
| (SCLC)                                                                                 |                                                                                             |
| a type of lung cancer making up around 10–15% of all lung cancers. See also            | non-small-                                                                                  |
| cell lung cancer                                                                       |                                                                                             |
| Squamous carcinoma                                                                     | a type of cancer arising from cells that line body cavities                                 |
| Staging/stage                                                                          | the anatomical extent of a cancer                                                           |
| Strategic Clinical                                                                     |                                                                                             |
| Network (SCN)                                                                          |                                                                                             |
| a system within the NHS to organise the integrated care of patients across a           |                                                                                             |
| geographical region                                                                    |                                                                                             |
| Surgical resection                                                                     | an operation to remove abnormal tissues or organs                                           |
| Tertiary centres                                                                       | hospitals that specialise in diagnosis and treatment of specific conditions, often handling |
| very complex cases. Other hospitals may refer patients to these centres for specialist |                                                                                             |
| treatment                                                                              |                                                                                             |

## Our Partners

2014 in review 
*
37,409 
patient records submitted 162 
surgical treatment in NSCLC 
anticancer treatment in 
*These totals include Scotland data.

participating organisations 
*
78% 
had contact with a specialist nurse 
10 
recommendations for improvement Royal College of Physicians 
11 St Andrews Place Regent's Park London NW1 4LE 
National Lung Cancer Audit Clinical Effectiveness and Evaluation Unit Email: nlca@rcplondon.ac.uk www.rcplondon.ac.uk/nlca National Lung Cancer Audit