Activity Report March 2012 February 2013

Transcription

1 Lung Cancer Managed Clinical Network Activity Report March 2012 February 2013 John McPhelim Lead Lung Cancer Nurse MCN Clinical Lead Kevin Campbell Network Manager

2 CONTENTS EXECUTIVE SUMMARY 3 1. INTRODUCTION 4 2. MCN WORKPLAN AND ACTIVITIES (REPORTING PERIOD 03/2012 TO 02/2013) CORE OBJECTIVES INDIVIDUAL MCN OBJECTIVES OTHER MCN ACTIVITIES 5 3. QUALITY ASSURANCE / SERVICE DEVELOPMENT AND IMPROVEMENT 6 4. KEY PRIORITY AREAS FOR THE MCN IN THE NEXT 12 MONTHS 7 5. CONCLUSION 8 ACKNOWLEDGEMENT 9 2

3 Executive Summary Introduction The purpose of this document is to report the Lung Cancer Managed Clinical Network (MCN) activities in respect of: Performance against agreed work plan objectives; Outcomes achieved; Challenges encountered and actions taken to remedy defined issues. This activity report covers March 2012 to February It also reports on key audit findings and resultant actions from the 2011 clinical audit, as well as looking forward from March 2013 to February MCN Objectives The Lung Cancer MCN has made progress and delivered a number of key objectives which include: Implementation of Regional Follow Up Consensus Guidance: Indications are that local implementation has taken place and there is broad adherence to the guidance, although there is reported variability due to availability of clinical nurse specialists. Regional Clinical Audit: The 2011 clinical audit data report was published in October Action plans have been produced by the Boards in response and progress against outstanding actions will be monitored by the Advisory Board. Quality Performance Indicator (QPI) development: Lung Cancer QPIs were published in December 2012 and the revised clinical audit data set will be implemented across Scotland from 1 April This programme will facilitate ongoing local and regional comparative assessment and will also enable periodic national comparative reporting of performance. Clinical Management Guideline (CMG) Review: CMGs for the management of small cell and non small cell lung cancers have been developed by the MCN and are currently being progressed through the approval process. A small group has also been working on development of a CMG for the management of massive haemoptysis. This is nearing conclusion and is expected will be available for final review and approval for introduction by the end of March Detect Cancer Early (DCE): The MCN has participated in discussions with the Scottish Government regarding a potential lung cancer specific component of the social marketing campaigns. Also discussed was the potential utilisation of the Early CDT Lung test trial as part of the DCE work. Brachytherapy: There is mixed evidence to support this treatment modality and centres operating pilot services were asked to review their provision and to feedback their experiences to the national radiotherapy programme board to facilitate national learning. Key Priority Areas for the MCN in the next 12 months The MCN work plan has been developed with an emphasis on identifying outcomes that improve the quality of patient care and overall efficiency. Below are the objectives to be progressed in the coming year: Continue to support the regional clinical audit programme and effectively utilise audit findings to inform and drive service improvement; Participate in the national review of referral guidelines in support of the DCE programme; and Epidermal Growth Factor Receptor (EGFR) and Aniplastic Lymphoma Kinase (ALK) testing implementation plan. 3

4 1. Introduction The West of Scotland Cancer Lung Cancer Managed Clinical Network (MCN) was established a decade ago with the ambition of delivering high quality, equitable clinical care to all lung cancer patients within the constituent NHS Boards that comprise the West of Scotland (WoS) region; Ayrshire & Arran, Forth Valley, Greater Glasgow and Clyde and Lanarkshire. The MCN continues to support and develop the clinical service for approximately 2,500 new lung cancer patients each year and management of this patient group relies heavily on close collaboration between the respiratory physicians, oncologists, surgeons, pathologists, radiologists, palliative care and clinical nurse specialists who comprise the 7 multi-disciplinary teams within the region. Of the 2465 new diagnoses of cancer recorded by the MCN clinical audit programme in 2011, 78 were mesothelioma and 2387 were primary lung, of which 1226 (51%) were male and 1161 (49%) female. Lung cancer continues to be more prevalent in patients aged over 60 years (86% in 2011) and incidence in males continues to fall while, conversely, it continues to rise in females. Primary treatment for lung cancer is predominantly non-surgical; only around 12% of patients undergo surgery and only half of these are potentially curable. The purpose of this document is to report the Lung Cancer MCN activities in respect of: Performance against agreed objectives; Outcomes achieved; Challenges encountered and actions taken to remedy defined issues; and Update on progress of actions identified from the Audit Report. MCN Governance The Advisory Board, which comprises representation from relevant clinical speciality groups and from the four constituent WoS Boards, meets three times each year to review progress against agreed service improvement objectives. The Advisory Board is consulted between meetings as required by the Network Manager and Clinical Lead. John McPhelim has now replaced Dr Richard Jones as the Clinical Lead for the MCN and the Advisory Board membership and terms of reference have been reviewed to ensure continued engagement with all the relevant clinical specialties across the four constituent WoS Boards. 2. MCN Work plan and Activities (reporting period 03/2012 to 02/2013) 2.1 Core Objectives Implementation of Regional Follow Up Consensus Guidance The Regional Consensus Guidance (RCG) for Lung Cancer was published and circulated for implementation in October Indications are of that local implementation has taken place and there is broad adherence to the guidance, although there is some reported variability due to availability of clinical nurse specialists. There are also indications that implementation of the guidance has led to better coordination of follow-up care. 4

5 Regional Clinical Audit Programme Effective utilisation of audit data to support service improvement is a key objective of the Lung Cancer Managed Clinical Network. The report of 2011 audit data identified a number of aspects of service provision requiring further local scrutiny and health boards are preparing actions plans identifying any resulting issues and how these will be resolved. Overall data quality has improved in recent years however in a small number of areas further improvement is required. One such area is coding of stage of disease which may also be linked with lower than expected rates of histological or cytological diagnosis. A revised national data set for lung cancer audit will be introduced on 1 April 2013 as part of the implementation of the Lung Cancer Quality Improvement Indicator programme. This should support national consistency and improved quality of data recording. 2.2 Individual MCN Objectives National Quality Performance Indicator (QPI) Development Programme The Scottish Cancer Taskforce Quality Subgroup is currently taking forward the development of national Quality Performance Indicators (QPIs) for all cancers. MCN members were well represented in the group tasked with developing the QPIs. The Lung Cancer QPIs were published in December 2012 and the revised clinical audit data set, which will capture the data require to assess these quality measures, will be implemented across Scotland from 1 April This programme will facilitate ongoing local and regional comparative assessment and will also enable periodic national comparative reporting of performance. It is anticipated that full collaboration with the National Cancer Lung Audit. Clinical Management Guidelines (CMGs) CMGs for the management of small cell and non small cell lung cancers have been developed by the MCN and are currently being progressed through the approval process. Following final approval the guidelines will be published on the (WoSCAN) intranet site. A small group has also been working on development of a CMG for the management of massive haemoptysis. This work is nearing conclusion and it is expected that this will be available for final review and approval for introduction by the end of March Detect Cancer Early (DCE) The MCN has participated in discussions with the Scottish Government regarding a potential lung cancer specific component of the social marketing campaigns. Topics discussed included the priming campaign accurate targeting of population groups, training needs for primary care and quality of currently available data. Also discussed was the potential utilisation of the Early CDT Lung test trial as part of the DCE work. Regional Testing Service for Epidermal Growth Factor Receptor (EGFR) Based on an audit of activity in the first half of 2012 it is expected that referrals for EGFR testing will average around 200 annually. The MCN education meeting in November provided an opportunity to focus on EGFR testing and describe how to access this service at the new laboratories at the Southern General Hospital in Glasgow. Further work on EGFR is being considered for next year with the potential development of a referral pathway to access this service. 2.3 Other MCN Activities Education The MCN continues to support two regional educational events each year. The first of the regional events focussed on mesothelioma, current and future trials and also the legal aspects of asbestos related disease. The programme also includes a presentation on resection of lung cancer and the variations in practice observed. 5

6 Included in the programme for the second event were the results from analysis of the latest audit data and also an overview of the survival outcomes for West of Scotland patients. The MCN also contributed to the national audit meeting in November, hosted by the South East Cancer Network. Brachytherapy MCN members have contributed to national discussions regarding the potential development of lung brachytherapy services following a national brachytherapy review, published in December There is mixed evidence to support this treatment modality and centres operating pilot services were asked to review their provision and to feedback their experiences to the national radiotherapy programme board to facilitate national learning. Scottish Intercollegiate Guideline Network (SIGN) MCN members have been involved in updating the current guideline on Lung Cancer which will incorporate new evidence on chemotherapy, surgery, radiotherapy. This is scheduled to be published in spring Once published, the MCN will review and consider potential implications of the guideline and advise members of its availability. 3. Quality Assurance / Service Development and Improvement The primary function of the MCN is to facilitate continuous clinical service improvement, supporting delivery of high-quality, equitable, treatment and care to patients with lung cancer in the West of Scotland. The MCN prospective clinical audit programme underpins much of the regional service development and improvement work of the MCN and supports quality assurance (QA) by providing the means for regular assessment and reporting against recognised and agreed measures of service performance and quality. The annual regional quality assurance of service provision utilises fifteen nationally recognised Standards (Health Improvement Scotland (HIS) formerly Quality Improvement Scotland) and the latest report of audit data is based on 2387 new diagnoses of lung cancer presenting in 2011, set against results obtained from the previous reporting period. The MCN QA process requires local multi-disciplinary teams to critically review and verify their own results before these are collated to provide a regional comparative report of performance against agreed measures. The report of the 2011 clinical audit data was published in November 2012 and can be found in the WoSCAN internet site. Regional Audit and Governance Process In accordance with agreed governance procedures, Boards were asked to produce Action/Improvement Plans, in response to audit findings, to take forward recommendations set out in the Audit Report; the expectation thereafter is that these actions will be progressed and monitored via local governance structures. Plans are expected to be submitted to the Regional Information Manager within two months of publication of the report. An Action/Improvement Plan template is provided to ensure consistency and standardisation across the region. The MCN Manager/Clinical Lead have been reviewing Board Action Plans to identify priorities for co-ordinated regional action and these, along with progress against specific Board actions are monitored throughout the year by the Advisory Board under the standing MCN Work Plan agenda item. Action Plan Progression Recommended actions on the basis of the key findings of the audit report were directed to Boards requesting that local plans are developed to address areas of deficiency identified. All of the Boards have produced Action/Improvement plans and outlined below is a high level summary of progress: 6

7 Ayrshire, North Glasgow and South Glasgow have reviewed their diagnostic procedures. Glasgow have indicated that histological confirmation is obtained in patients for whom a confirmed diagnosis where this may influence their management; approximately one third of patients have a poor performance status and tissue diagnosis would cause distress and discomfort and would not alter planned management. Ayrshire and Arran indicated that they will be able to provide an endobronchial ultrasound (EBUS) service starting early in Boards have identified a number of possible reasons for the very small numbers of patients recorded as not having been discussed at an MDT. Glasgow, for example, has identified that 22 patients (8%) were not identified to the respiratory team and were therefore not presented to the MDT for review. In response to the recommended action Lanarkshire have raised awareness within the MDT of the need to ensure that TNM stage is discussed and agreed at the MDT and recorded in the notes. Glasgow have reported that a local review has identified that where patient performance status is not documented at the MDT meeting this is predominantly cases where supportive care only is recommended. Boards have indicated a lack of availability of data from the Beatson West of Scotland Cancer Centre (BWoSCC). All necessary data must be readily accessible to clinical effectiveness staff to ensure completeness and accuracy of clinical audit data recorded on ecase. MDTs have indicated that awareness has been raised within local teams regarding requirements to use TNM 7 in the staging of mesothelioma and to discuss and agree staging of all patients at the MDT meeting and to record the stage in the notes. Across all Boards all the actions identified in the Board-specific action/improvement plans have been reviewed and a progress/action status provided in line with the governance framework. The actions identified as not yet fully implemented will be reviewed by the Network Advisory Board. Escalation Process Any service or clinical issue which the Advisory Board considers not to have been adequately addressed will be escalated to the Regional Lead Cancer Clinician and relevant NHS Board Cancer Clinical Lead by the MCN Clinical Lead. 4. Key Priority Areas for the MCN in the next 12 months The MCN work plan is currently being developed with an emphasis on identifying outcomes that improve the quality of patient care. Below are the objectives currently being developed for the work plan in the coming year, 2013/14: Continue to support the regional clinical audit programme and effectively utilise audit findings to inform and drive service improvement. Participate in the national review of referral guidelines in support of the DCE programme. Define patient referral pathways for Epidermal Growth Factor Receptor (EGFR) and Aniplastic Lymphoma Kinase (ALK) testing. Further develop care post completion of acute treatment. This will be taken forward as part of the Transforming Care after Treatment Programme. 7

8 5. Conclusion The MCN has made good progress in regard to the work plan and the continuing support of the Advisory Board members is critical to delivery of the identified outcomes. Adoption of the finalised CMGs for small cell lung cancer and management of massive haemoptysis will facilitate equity of treatment and care across the region as does the successful implementation of the regional consensus guidance for follow up. These developments will continue to drive consistency of practice and provide improved care for patients with lung cancer. One of the most significant challenges to improving outcomes for lung cancer patients is to increase early detection rates and the MCN will continue to input, as requested, to the Detect Cancer Early programme and the national review of referral guidelines. Targeted therapies offer improved treatment options for some patients and the MCN will support this area of service enhancement through development of referral pathways for EGFR and ALK testing; the determinants of patient suitability for these therapies. 8

9 Acknowledgement This report represents the achievements and challenges progressed across the four partner NHS Boards of the : NHS Ayrshire & Arran NHS Forth Valley NHS Greater Glasgow and Clyde NHS Lanarkshire We would like to thank all members and active participants in the cancer network for their continued support of the Managed Clinical Network, without their efforts this level of progress would not be possible. 9