Source · GIRFT National Specialty Report
Lung Cancer
Published 1 October 2022
Lung Cancer
GIRFT Programme National Specialty Report on lung cancer
Summary
33 recommendations
27 addressees
1 of 33 linked to a body
Recommendations
Rec 1
Trusts; imaging networks; Cancer Alliances; commissioners; NHS England
Respiratory teams to immediately move to providing proactive management of unexpected abnormal chest radiology and work with radiology departments to implement pathways that deliver a three working day turnaround from abnormal chest X-ray or referral to CT scan report.
Rec 2
Trusts
Key diagnostic investigations should be completed within 21 calendar days of the start of the pathway by adopting best practice recommendations on service configuration and pathway planning.
Rec 3
NHS England; Trusts; PET-CT providers; imaging networks; NHSE Specialised Commissioning
Renegotiate the national PET-CT contract to include a five calendar day turnaround from request to report and available imaging for initial investigations of new diagnoses of lung cancer.
Rec 4
Trusts; Cancer Alliances
An image-guided biopsy service should be available for all patients 52 weeks of the year, with appointments for the procedure being available (notwithstanding issues such as anti-coagulation or anti-platelet therapy) within five working days of the request.
Rec 5
Trusts; Health Education England; Cancer Alliances; Lung CEG
EBUS for lung cancer should be available within five calendar days of request and must comply with the national service specifications, with regular monitoring of performance by local commissioners.
Rec 6
Trusts
Ensure a diagnostic and therapeutic ambulatory pleural service is available for all lung cancer patients, accessible within five working days, 52 weeks of the year.
Rec 7
NHS England; Trusts; Genomic Laboratory Hubs; Cancer Alliances; commissioners; RCPath; NHSE/I; Genomics …
Pathological services should provide a maximum ten calendar day turnaround time for molecular profiling according to the national test directory of lung cancers to meet the requirements of the NOLCP.
Rec 8
Commissioners; Trusts; Cancer Alliances
Commission a specific, robust and predominantly virtual nodule pathway which is separate from the lung cancer MDT/MDM.
Rec 9
Trusts; Cancer Alliances; Specialised Commissioning; NLCA
All trusts should have an overall radical treatment rate of 85% or more in those patients with NSCLC stages I-II and of performance status 0-2. This includes all treatment modalities (surgery, radiotherapy including SABR, multimodality treatment and thermoablative techniques).
Rec 10
Surgical centres; Trusts; Cancer Alliances; CCGs; ICS
All trusts should have an overall surgical resection rate for NSCLC of over 20%.
Rec 11
NHS England; Health Education England; Trusts
All trusts that treat lung cancer with radiotherapy should be able to deliver SABR in line with the clinical commissioning policy.
Rec 12
Trusts; National Cancer Research Institute; radiotherapy ODNs; Cancer Alliances
All trusts should deliver radiotherapy in line with the Royal College of Radiologists consensus statements.
Rec 13
Trusts; Cancer Alliances
Where a patient has early stage disease but is declined for radical treatment, or does not have access to the full range of radical treatment options, more effective mechanisms should exist for a second opinion.
Rec 14
NLCA; Trusts; Cancer Alliances
Trusts should monitor rates of post-surgical adjuvant and neoadjuvant treatments and this data should be available for national benchmarking.
Rec 15
Trusts; Radiotherapy ODNs; NLCA
Trusts should record and monitor multimodality treatment in stage IIIA disease and offer radical intent treatment as standard in fit patients.
Rec 16
Trusts
Radical intent treatment should commence by day 49 of the overall NOLCP pathway. Furthermore, for surgery, thermoablation or radiotherapy, treatment should commence by day 16 after the decision to treat in line with NOLCP.
Rec 17
Cancer Alliances; Trusts; Research organisations; clinical researchers; NHS England
All trusts should improve their treatment rates with SACT to achieve greater than 70% treatment for fit patients with advanced NSCLC, and greater than 70% chemotherapy rates in small cell lung cancer.
Rec 18
Trusts; CCGs
Ensure that all patients with lung cancer have access to enhanced supportive care and/or specialist palliative care. Inpatient specialist palliative care provision should be available seven days per week.
Rec 19
Cancer Alliances; Trusts; NCRI
Produce and implement protocols for follow-up pathways following radical therapies.
Rec 20
Trusts; Cancer Alliances; Funding bodies
Clinical trial recruitment should be considered a focus for prioritisation, with MDTs collaborating to offer a wider regional portfolio.
Rec 21
Trusts
Review operational arrangements for multidisciplinary working to ensure it is as timely, efficient, and effective as possible and meeting the needs of patients.
Rec 22
Trusts; primary care; Cancer Alliances
Improve timeliness and effectiveness of communication from the MDT to lung cancer patients and primary care.
Rec 23
NHSE/I; HQIP; NLCA; NCRAS; Trusts
Continue the NLCA in the long-term in order to quality assure and improve services and bring the clinical community together with a shared purpose.
Rec 24
NHS England; Trusts; GIRFT
Monitor and performance manage trusts according to the key time points within the NOLCP.
Rec 25
Trusts; NHS England; NLCA
Collect, analyse and publish an agreed EBUS dataset aligned to agreed performance metrics and standards.
Rec 26
Trusts
Improve the annual review of data within lung cancer services.
Rec 27
NHS England; NCRAS; NLCA; Lung Cancer CEG
Develop more relevant and generalisable methods of collecting data on patient-reported experience and outcomes.
Rec 28
Trusts
Ensure all lung cancer MDTs have a named clinical lead for the service, with job planned time for the role to allow for service development and management.
Rec 29
CEG; NHS England; Health Education England; Trusts; Cancer Alliances
Ensure all lung cancer MDTs have appropriately skilled practitioners across the whole range of medical, nursing and allied health professions and healthcare scientists, able to give the same levels of high-quality care to all patients in all areas of the country 52 weeks of the year.
Rec 30
Cancer Alliances; Trusts
Review the process for funding allocations to ensure that transformation funding is used as effectively as possible.
Rec 31
NHS England; Public Health England; Health Education England; Society of Radiographers
Roll out national implementation of risk-based CT screening for lung cancer.
Rec 32
NHS England
Ensure that a clinical reference group continues to be available to provide strategic and clinical advice.
Full addressee: NHSE/I
Rec 33
Public Health England; Trusts; Chemotherapy CRG; academic groups
National bodies and local lung cancer services should continue to respond to the challenges presented by the COVID-19 pandemic.