Implementing the Optimal Lung Cancer Pathway

Transcription

1 Implementing the Optimal Lung Cancer Pathway Climbing out of the too hard pile Liz Fuller -NCA clinical Lead Lung Sheron Robson -NCA programme manager Chris Tasker -CRUK Strategic GP Collaborating to improve cancer care

2 Content of workshop Why focus on Lung Cancer What has been achieved so far Barriers to early diagnosis identified Going further along the pathway Issues for Commissioners Anything missing Prevention, Lung screening, safety netting in Primary care Collaborating to improve cancer care

3 Alliance Rankings National Lung Cancer Incidence Slide from Linda Wintersgill Northern Cancer Alliance 140 Clinical Networks : Lung Clinical Cancers Networks (ICD C33-C34, : Lung Cancers C37-38, (ICD C39, C33-C34, C45) : Age/Sex C37-38, Standardised C39, C45) : Age/Sex Incidence Standardised Incidence Rates : Males Rates : Females (Source : National Cancer Registration Service Cancer Analysis System, snapshot CAS1602) (Source : National Cancer Registration Service Cancer Analysis System, snapshot CAS1602) Clinical Networks : Lung Cancers (ICD C33-C34, C37-38, C39, C45) : Age/Sex Standardised Incidence Rates : Persons (Source : National Cancer Registration Service Cancer Analysis System, snapshot CAS1602) Northern Cheshire and Greater Yorkshire and East Midlands North West North and West East of South East Wessex South West Thames Northern England 20 Cheshire and Merseyside Greater EnglandYorkshire Merseyside and North Manchester, and East Midlands The Humber North West Manchester, The Humber East London Lancashire and South Lancashire and South Cumbria and South Cumbria London West and South East East of London South West Midlands South East England Wessexcoast Midlands London England coast Thames Valley Valley Northern England Cheshire and Merseyside Greater Manchester, Lancashire and South Cumbria Yorkshire and The Humber North and East Midlands North West East London and South London West Midlands East of England South East coast South West Wessex Thames Valley

4 NCA Lung Cancer Incidence 2014 Lung Cancer makes up 17.2% of all cancers, 2 nd highest grouping Slides from Linda Wintersgill NCA CWT Group Totals Northern England Male Female Persons Head and Neck OesophagoGastric Hepato Pancreatic Biliary ,046 Lower Gastrointestinal 1,457 1,083 2,540 Lung 1,842 1,678 3,520 Skin Sarcoma Breast 18 3,014 3,032 Gynaecological - 1,081 1,081 Urological 3, ,880 Brain and CNS Other Haematological ,636 Total 10,370 10,181 20,551

5 NHS Cumbria NHS Darlington NHS Durham Dales, Easington & Sedgefield NHS Hambleton, Richmondshire & Whitby NHS Hartlepool & Stockton-on-Tees NHS Newcastle Gateshead NHS North Durham NHS North Tyneside NHS Northumberland NHS South Tees NHS South Tyneside NHS Sunderland NHS Cumbria NHS Darlington NHS Durham Dales, Easington & Sedgefield NHS Hambleton, Richmondshire & Whitby NHS Hartlepool & Stockton-on-Tees NHS Newcastle Gateshead NHS North Durham NHS North Tyneside NHS Northumberland NHS South Tees NHS South Tyneside NHS Sunderland NHS Cumbria NHS Darlington NHS Durham Dales, Easington & Sedgefield NHS Hambleton, Richmondshire & Whitby NHS Hartlepool & Stockton-on-Tees NHS Newcastle Gateshead NHS North Durham NHS North Tyneside NHS Northumberland NHS South Tees NHS South Tyneside NHS Sunderland Lung Cancer Incidence 2014 by CCG Slides from Linda Wintersgill NCA NESCN : Lung Cancers (C33-C34, C37, C45, C39, C38) : Age/Sex Standardised Incidence Rates - CCGs (Source : National Cancer Registration Service Cancer Analysis System, snapshot CAS1602) Male Female Persons

6 The other risk factor age NCA Lung cancer Incidence 2014 Age Standardised Rates by Age- Band National Cancer registration Service Cancer Analysis System, snapshot CAS1602 Linda Wintersgill NCA NECN - Lung Cancer Incidence Age-Standardised Rates by Age-Band (Source : National Cancer Registration Service Cancer Analysis System, snapshot CAS1602) Male Female Persons

7 Observed and Projected Lung Cancer Incidence rates Graph from Cancer Research UK

8 Lung cancer Survival Statistics Infographic from CRUK

9 NCA Lung Cancer Mortality 2014 Lung Cancer makes up 28% of all cancer deaths, the top cause. Slides from Linda Wintersgill NCA CWT Group Totals Northern England Male Female Persons Head and Neck OG HPB ,120 Lower Gastrointestinal Lung 1,433 1,314 2,747 Skin Sarcoma Breast Gynae Urology 1, ,290 BrainCNS Other Haem ,307 4,609 9,916

10 ACHIEVING WORLD-CLASS CANCER OUTCOMES A STRATEGY FOR ENGLAND Recommendation 24 By the end of 2015, NHS England should develop the rules for a new metric for earlier diagnosis measurable at CCG level. Patients referred for testing by a GP, because of symptoms or clinical judgement, should either be definitively diagnosed with cancer or cancer excluded and this result should be communicated to the patient within four weeks. The ambition should be that CCGs achieve this target for 95% of patients by 2020, with 50% definitively diagnosed or cancer excluded within 2 weeks. Once this new metric is embedded, CCGs and providers should be permitted to phase out the urgent referral (2-week) pathway. Collaborating to improve cancer care

11 National Optimal Lung Cancer Pathway NHS England requested that the Respiratory Clinical Expert Group provided commission guidance for Whole Lung Cancer Pathway National Optimal Lung Cancer Pathway, April 2016 Updated June 2017 Collaborating to improve cancer care

12 National Optimal Lung Cancer Pathway NOLCP There is now an alternative pathway: rapid pathway which is being used in Manchester Both pathways ensure that patients are informed of their cancer diagnosis by day 28 (Rapid by day 14) The NOLCP also hopes that treatment starts by day 62

13 Quarterly performance Lung Cancer Top table 62D 2016/17 Bottom table time series 62D Data from Linda Wintersgill NCA 62 day 2WW Referrals S Tyneside Sunderland N Cumbria Gateshead Newcastle Northumbria S Tees North Tees & Hartlepool Durham & Darlington NECN National Q1 Q2 Q3 Q4 87 (10/11.5) 71.4 (5/7) 45.7 (8/17.5) 67.4 (14.5/21.5) 76 (47.5/62.5) 85.2 (11.5/13.5) 65.5 (37/56.5) 61.9 (19.5/31.5) 69.3 (26/37.5) 69.1 (179/259) (24/26) 76.3 (14.5/19) 71.1 (13.5/19) 93.1 (13.5/14.5) 69.2 (37/53.5) 73.1 (9.5/13) 57.1 (32/56) 66.2 (22.5/34) 74.4 (33.5/45) 71.4 (200/280) (14.5/14.5) (9.5/13) (11.5/15) (11/17.5) (44.5/58.5) (10.5/17) 69.5 (49/70.5) (30.5/39) (29.5/47.5) (210.5/292.5) (14/14.5) (9.5/14) (8/14) (17/19.5) (43.5/59.5) (12/15.5) (35.5/43.5) (17/22.5) (29.5/41) (186/244) 70.7 Q1 09/10 Q2 09/10 Q3 09/10 Q4 09/10 Q1 10/11 Q2 10/11 Q3 10/11 Q4 10/11 Q1 11/12 Q2 11/12 Q3 11/12 Q4 11/12 Q1 12/13 Q212/13 Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Q3 13/14 Q4 13/14 Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Q1 16/17 Q2 16/17 Q3 16/17 Q4 16/17 S Tyne 91.4 (16/17.5) 86.7 (6.5/7.5) 91.7 (5.5/6) 85 (8.5/10) 95.5 (10.5/11) 80 (14/17.5) 82.8 (12/14.5) 88.2 (15/17) 83.3 (15/18) 93.2 (20.5/22) 68.4 (6.5/9.5) 85.7 (15/17.5) 76 (9.5/12.5) 78.6 (16.5/21) 87 (20/23) 85.2 (11.5/13.5) 91.7 (11/12) 100 (14/14) 87.5 (10.5/12) 92.3 (18/19.5) 89.3 (12.5/14) 90.2 (23/25.5) 96.6 (14/14.5) 83.3 (15/18) 100 (9/9) 96.6 (14/14.5) 91.7 (16.5/18) 83.9 (13/15.5) 87 (10/11.5) 92.3 (24/26) 100 (14.5/14.5) (14/14.5) Sunderland 80.4 (22.5/28) 70.9 (19.5/27.5) 52.8 (14/26.5) 70 (14/20) 85.3 (14.5/17) 89.1 (20.5/23) 86.7 (19.5/22.5) 77.1 (18.5/24) 84.8 (19.5/23) 94.6 (17.5/18.5) 73.2 (15/20.5) 73.7 (14/19) 86.8 (16.5/19) 79 (24.5/31) 98.1 (26/26.5) 82.2 (18.5/22.5) 82.2 (18.5/22.5) 70.4 (19/27) 55.4 (15.5/28) 76.5 (13/17) 80.7 (23/28.5) 60.9 (7/11.5) 73.9 (8.5/11.5) 70 (7/10) 83.3 (5/6) 61.1 (5.5/9) 62.5 (7.5/12) 61.5 (4/6.5) 71.4 (5/7) 76.3 (14.5/19) (9.5/13) (9.5/14) N Cumbria 95.2 (20/21) 93.8 (30.5/32.5) 95.9 (23.5/24.5) 82.3 (25.5/31) 87 (10/11.5) 97.4 (19/19.5) 91.1 (20.5/22.5) 86.2 (25/29) 90.4 (23.5/26) 83 (22/26.5) 90 (22.5/25) 90 (22.5/25) 77.3 (17/22) 67.3 (18.5/27.5) 78.9 (22.5/28.5) 62.3 (16.5/26.5) 62.5 (17.5/28) 64.6 (15.5/24) 64.4 (14.5/22.5) 51.5 (8.5/16.5) 68.8 (11/16) 75 (10.5/14) 58.6 (8.5/14.5) 93.3 (7/7.5) 42.5 (8.5/20) 65.9 (14.5/22) 45.5 (5/11) 77.3 (8.5/11) 45.7 (8/17.5) 71.1 (13.5/19) (11.5/15) (8/14) Gateshead 80 (12/15) 71 (11/15.5) 91.7 (11/12) 77.8 (7/9) 76.7 (16.5/21.5) 89.7 (13/14.5) 96.8 (15/15.5) 77.8 (17.5/22.5) 72.2 (13/18) 80 (16/20) 74.5 (19/25.5) 73.3 (11/15) 75.5 (18.5/24.5) 89.8 (22/24.5) 73.9 (8.5/11.5) 73 (13.5/18.5) 75.7 (14/18.5) 79.2 (19/24) 81.3 (19.5/24) 61.9 (13/21) 85.4 (20.5/24) 63.3 (9.5/15) 70 (14/20) 86.5 (16/18.5) 74.2 (11.5/15.5) 69.7 (11.5/16.5) 81.6 (15.5/19) 84.4 (13.5/16) 67.4 (14.5/21.5) 93.1 (13.5/14.5) (11/17.5) (17/19.5) Newcastle 67 (31.5/47) 60.3 (23.5/39) 78.2 (34/43.5) 90.1 (41/45.5) 86.2 (28/32.5) 77.1 (37/48) 81.7 (38/46.5) 74.8 (49/65.5) 75.5 (40/53) 76.6 (41/53.5) 75.7 (42/55.5) 76.4 (47/61.5) 79 (47/59.5) 72.1 (37.5/52) 70.2 (40/57) 77.4 (32.5/42) 82.7 (40.5/49) 74.1 (31.5/42.5) 69.9 (36/51.5) 77.3 (46/59.5) 76.9 (41.5/54) 72.2 (32.5/45) 79.6 (41/51.5) 74.5 (41/55) 73.2 (35.5/48.5) 67.2 (40/59.5) 67.6 (36.5/54) 73.9 (42.5/57.5) 76 (47.5/62.5) 69.2 (37/53.5) (44.5/58.5) (43.5/59.5) Northumbria 89.8 (22/24.5) 87 (23.5/27) 90 (13.5/15) 89.6 (30/33.5) 90 (27/30) 96.1 (36.5/38) 75 (19.5/26) 70.4 (19/27) 81.8 (22.5/27.5) 75.3 (30.5/40.5) 87.1 (27/31) 83.6 (25.5/30.5) 82.4 (14/17) 80 (12/15) 92.3 (12/13) 100 (11.5/11.5) 79.2 (9.5/12) 79.4 (13.5/17) 95.8 (11.5/12) 88.5 (11.5/13) 82.1 (16/19.5) 81.3 (13/16) 87.9 (14.5/16.5) 92.9 (13/14) 81.1 (15/18.5) 83.9 (13/15.5) 89.7 (13/14.5) 77.4 (12/15.5) 85.2 (11.5/13.5) 73.1 (9.5/13) (10.5/17) (12/15.5) S Tees 78.7 (50/63.5) 87.5 (38.5/44) 83.1 (34.5/41.5) 87.2 (47.5/54.5) 84.8 (39/46) 79.2 (38/48) 86.2 (37.5/43.5) 77.2 (44/57) 74.6 (45.5/61) 88.8 (59.5/67) 83.7 (41/49) 86.6 (42/48.5) 88.2 (52.5/59.5) 75 (48/64) 91.8 (56/61) 85 (48/56.5) 80.2 (48.5/60.5) 68.6 (41.5/60.5) 62.3 (40.5/65) 72.3 (36.5/50.5) 78.6 (46/58.5) 76.8 (31.5/41) 72.7 (36/49.5) 75.6 (34/45) 69.4 (43/62) 69.4 (43/62) 57.7 (30/52) 49.4 (22/44.5) 65.5 (37/56.5) 57.1 (32/56) 69.5 (49/70.5) (35.5/43.5) N Tees & Hartlepool 83.3 (25/30) 91.1 (20.5/22.5) 90 (18/20) 88.1 (18.5/21) 81.3 (26/32) 85.5 (29.5/34.5) 83.3 (22.5/27) 78.1 (28.5/36.5) 77.8 (24.5/31.5) 83.8 (31/37) 86.2 (28/32.5) 87.2 (20.5/23.5) 87.2 (17/19.5) 72.9 (25.5/35) 91.3 (21/23) 83.3 (20/24) 77.6 (19/24.5) 74.6 (22/29.5) 72.4 (21/29) 84.3 (21.5/25.5) 69.9 (29/41.5) 78.9 (22.5/28.5) 68.9 (15.5/22.5) 62.1 (20.5/33) 67.2 (20.5/30.5) 66.2 (22.5/34) 77.6 (26/33.5) 75.4 (24.5/32.5) 61.9 (19.5/31.5) 66.2 (22.5/34) (30.5/39) (17/22.5) CDDFT 78.2 (30.5/39) 80.3 (28.5/35.5) 80.3 (28.5/35.5) 76.2 (24/31.5) 96.6 (28.5/29.5) 86.8 (39.5/45.5) 78.5 (25.5/32.5) 70 (21/30) 75.4 (24.5/32.5) 78.8 (26/33) 84 (34/40.5) 84.3 (29.5/35) 87.5 (35/40) 81.5 (33/40.5) 75 (22.5/30) 87.1 (27/31) 78.3 (32.5/41.5) 80.3 (24.5/30.5) 84 (42/50) 67.7 (21/31) 60 (22.5/37.5) 78.9 (22.5/28.5) 77.9 (30/38.5) 73.1 (24.5/33.5) 64.5 (20/31) 77 (33.5/43.5) 82.1 (32/39) 69.9 (32.5/46.5) 69.3 (26/37.5) 74.4 (33.5/45) (29.5/47.5) (29.5/41) Total 80.4 (229.5/285.5) 80.5 (202/251) 81.3 (182.5/224.5) 84.4 (216/256) 86.6 (200/231) 85.6 (247/288.5) 83.8 (210/250.5) 77 (237.5/308.5) 78.5 (228/290.5) 83 (264/318) 81.3 (235/289) 82.4 (227/275.5) 83 (227/273.5) 76.5 (237.5/310.5) 83.5 (228.5/273.5) 80.9 (199/246) 78.6 (211/268.5) 74.5 (200.5/269) 71.8 (211/294) 74.6 (189/253.5) 75.6 (222/293.5) 76.4 (172/225) 76.2 (182/239) 75.9 (178/234.5) 69.7 (168/241) 71.4 (197.5/276.5) 71.9 (182/253) 70.3 (172.5/245.5) 69.1 (179/259) 71.4 (200/280) (210.5/292.5) (186/244)

14 Initial focus

15 NOLCP-diagnostic workup

16 Challenges/issues 2 ww referral pathway Reporting times CT slots Communication to patient Information from GP GP practices getting used to change in pathway Peaks and troughs Patient already known lung cancer

17 Common barriers to progress Radiology capacity Access to PET CT and turnaround times Access to Pathology / molecular testing and turnaround times Cross tumour pathways Collaborating to improve cancer care

18 Going further along the pathway Collaborating to improve cancer care

19 NOLCP-management plan workup

20 NOLCP-treatment

21 Future focus MDT 1 discussion with results Clinic space Consultant cross-cover Pathology Northern centre?one centre for all molecular tests Concurrent not sequential Test bundle Ambulatory Bx Oncology/surgery Cross-cover Review in 3 days Collaborating to improve cancer care

22 Issues for Commissioning the OLCP CCGs planning guidance Work to date has been cost neutral Workforce projections Opportunities as well as costs NCA Prevention Training Ambulatory Bx Collaborating to improve cancer care

23 Anything missing? Prevention More/different lung screening Safety netting in Primary care??? Collaborating to improve cancer care