Challenges for the Lung Cancer Pathway Group Liz Sawicka Chair Lung Pathway Group Thoracic Physician and Lung Cancer Lead Princess Royal University Hospital SLHT
2 The Problem - Varied outcome for patients with Lung Cancer across the LCA - Worse than much of Europe
3 The Problem Lung Cancer Survival in England is poor compared to Europe o Patients diagnosed 1996-2004 o 5yr survival for males o England 6.5% Sweden 11.3% o Differences greatest in first year BUT improving o Diagnosed 2005-9 o Age standardised 5 yr survival for males 8.2% Lung Cancer Survival varies across London o Better in areas with higher socio-economic status paralleled across urban and rural areas
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5 One year relative survival rates for Patients diagnosed 2006-8 Hillingdon 21.67 Lambeth 33.85 Bexley 25.58 Kingston 33.98 Ealing 26.98 Bromley 34.96 Greenwich 28.24 Croydon 34.97 Hounslow 30.15 Hammersmith & Fulham Lewisham 30.73 Sutton & Merton Wandsworth 31.89 Richmond & Twickenham 35.83 37.45 38.22 Southwark 33.25 Westminster 42.96 Kensington & Chelsea 43.49
6 Cancer in SE England 2011 (TCR) - variation in treatment in London 1 yr relative survival %Treatment recorded within 6 months of diagnosis Area Number Male Female Surgery Chemotherapy Radiotherapy NW 794 32.9 37.5 20 18 30 SE 771 30.9 35.3 19 26 27 SW 778 34.6 40.4 21 33 23
7 LUCADA Report for 2011 Surgery in Networks in LCA Nos NSCLC Stage 1A-2B % having surgery Patients operated NW 109 53.2 58 SE 124 49.2 61 SW 96 46.9 44 Total 329 163
8 To Solve Need robust DATA!!! And AUDIT
9 DATA! LUCADA report 2012 showed large variation in data recording across all units in LCA Stage recorded 59-97% Performance status recorded 55-99% Treatment recorded 71-100% Histological diagnosis 50-97%
10 What are the solutions? PATHWAY INTEGRATION Community Primary Care Secondary Care Tertiary Care Third Sector
11 Integration of pathways Variation in outcomes for lower and higher socio-economic groups 1 year survival variation largely due to differences in access and time to diagnosis Important that the integration of pathways includes Community patient awareness Primary Care Early Diagnosis screening, access to diagnostics from general practice?ct Improved access to secondary care and diagnostics
12 Integration of Pathways (2) Full membership of MDT High quality imaging Pathology including molecular testing Seamless integration with tertiary care and research Centralised specialist services -surgery, SABR Appropriate treatment delivery closer to home High quality supportive and palliative care meeting NICE guidelines Research User involvement Uniform, high quality patient information Key worker implementation Timely patient surveys by users/carers to inform improvements
13 The London Cancer Alliance West and South Change Presentation title and date in Footer dd.mm.yyyy Work to date
14 Report on the Future of Thoracic Surgery in the LCA All centres exceed the number of procedures in Model of Care (89-349 cases per annum) and all are specialist centres aligned to teaching facilities LCA has 4 centres serving 4.8 million Londoners and 8 million population from outside London Harefield only 10% patients from London Only one MDT lacks surgical representation due to be corrected this year Standards for high quality surgical care agreed and will be monitored through the LCA Report and conclusions accepted by Clinical Board, Member s Board and Clinical Commissioning Group
15 Achievements to date Agreed best practice pathways with commissioners Cost of integrated pathways to be agreed Need to challenge commissioners re: costs of molecular testing they view this aspect of pathology is included in current costs Developed Draft Network Guidelines
16 How do we involve everyone to achieve improvements in care? Stakeholder Groups will replace TWG/NSSGs, meeting 4 times per annum. MDT lead for site or deputy should attend as a minumum How do we agree agenda and work priorities? How do we ensure representation from the wider stakeholder group? How do we select? Term of office? Use advisory groups to inform Pathway Group Pathway group meets monthly with every third meeting with Stakeholders Peer review move to outcome measure rather than process Details of governance arrangements to be circulated
17 Contact details Liz Sawicka liz.sawicka@nhs.net