Just released: NLCA Spotlight Audit on Curative Intent Treatment

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The National Lung Cancer Audit (NLCA) Spotlight Audit on Curative Intent Treatment is published today.

This study was aimed at investigating why the curative intent treatment rates in patients with early-stage lung cancer are lower than expected and additionally to also explore the real-world management of patients with stage IIIa disease who did not have surgery.

78/133 (54%) of trusts invited to take part in the study agreed to participate (compared with 42% during 2017) providing data on 1,056 patients diagnosed in 2018 with stage Ia–IIb non-small-cell lung cancer (NSCLC) and 851 patients with stage IIIa disease.

Key findings included:

  • 15% (31% in 2015) of patients with stage Ia-IIb declined surgery due to patient wishes
  • 35% (46% in 2015) of patients with stage Ia-IIb who did not have surgery received no specific anti-cancer treatment
  • 62% (46% in 2015) of patients with stage Ia-IIb who did not have surgery did receive radiotherapy
  • Only 10% of patients with stage IIIa underwent a diagnostic MRI brain scan and only 35% had an EBUS
  • Only 12% of patients with stage IIIa who did not have surgery received concurrent chemo-radiotherapy

Key messages include:

  • Some patients with early stage lung cancer may still be missing out on receiving treatments with curative intent
  • Some patients with stage IIIa disease may be missing out on access to diagnostic procedures (such as MRI brain scans and EBUS) which could better inform treatment decisions
  • Although concurrent chemo-radiotherapy is considered optimal initial treatment for patients with inoperable stage IIIA disease, only 12% of patients in this cohort had this treatment and rates were significantly lower in women compared to men and in those aged >75.

Recommendations include:

  • MDTs should review case notes and clinical pathways to see if more early-stage patients could receive treatment with curative intent
  • MDTs should review case notes and clinical pathways to see if more patients with stage IIIa disease could be getting better access to diagnostics
  • MDTs should review case notes and clinical pathways to see if more stage IIIa patients could receive concurrent chemo-radiotherapy