Source · GIRFT National Specialty Report
Lung Cancer
GIRFT Programme National Specialty Report on lung cancer
Published 1 October 2022
Lung Cancer
Indexed content
33 recommendations
27 addressees
1 of 33 linked to a body
Recommendations
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.
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.
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.
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.
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.
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.
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.
Commission a specific, robust and predominantly virtual nodule pathway which is separate from the lung cancer MDT/MDM.
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).
All trusts should have an overall surgical resection rate for NSCLC of over 20%.
All trusts that treat lung cancer with radiotherapy should be able to deliver SABR in line with the clinical commissioning policy.
All trusts should deliver radiotherapy in line with the Royal College of Radiologists consensus statements.
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.
Trusts should monitor rates of post-surgical adjuvant and neoadjuvant treatments and this data should be available for national benchmarking.
Trusts should record and monitor multimodality treatment in stage IIIA disease and offer radical intent treatment as standard in fit patients.
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.
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.
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.
Produce and implement protocols for follow-up pathways following radical therapies.
Clinical trial recruitment should be considered a focus for prioritisation, with MDTs collaborating to offer a wider regional portfolio.
Review operational arrangements for multidisciplinary working to ensure it is as timely, efficient, and effective as possible and meeting the needs of patients.
Improve timeliness and effectiveness of communication from the MDT to lung cancer patients and primary care.
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.
Monitor and performance manage trusts according to the key time points within the NOLCP.
Collect, analyse and publish an agreed EBUS dataset aligned to agreed performance metrics and standards.
Improve the annual review of data within lung cancer services.
Develop more relevant and generalisable methods of collecting data on patient-reported experience and outcomes.
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.
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.
Review the process for funding allocations to ensure that transformation funding is used as effectively as possible.
Roll out national implementation of risk-based CT screening for lung cancer.
Ensure that a clinical reference group continues to be available to provide strategic and clinical advice.
Full addressee: NHSE/I
National bodies and local lung cancer services should continue to respond to the challenges presented by the COVID-19 pandemic.