network audit 2011-12 patients with confirmed small cell lung cancer who did not receive...
DESCRIPTION
NLCA Results 2010 Patients Code Actual number Number of patients small cell lung cancer % small cell receiving chemotherapy RE % RLN % RNL % RR % RTD % RTF % RTR % RVW % RXP % N36 Total2, % LUCADA Total 32,3473, %TRANSCRIPT
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Network Audit 2011-12Patients with Confirmed Small Cell Lung Cancer
Who Did Not Receive Chemotherapy
Dr D N LeitchOn Behalf of Lung Cancer NSSG
NECN
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Introduction
• National Lung Cancer Audit - “Chemotherapy rates for small cell lung cancer below the England and Wales average of 65 per cent should be reviewed”
• Important clinical line of enquiry used in Peer Review• Required consideration in annual self assessment report• If gone as far as confirming diagnosis – Why no treatment?
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NLCA Results 2010 Patients
CodeActual number
Number of patients small cell lung cancer
% small cell receiving chemotherapy
RE9 181 12 50.0%RLN 273 33 69.7%RNL 232 34 52.9%RR7 221 26 69.2%RTD 317 43 74.4%RTF 343 38 57.9%RTR 351 47 59.6%RVW 314 29 65.5%RXP 424 45 62.2%N36 Total 2,656 307 63.2%LUCADA Total
32,347 3,585 65.1%
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Methods
• Retrospective case note audit • All Trusts participated• Patients diagnosed with lung cancer during 12 months
01.01.2010 to 31.12.2010 • Results match the current 2011 National Lung Cancer Audit
(NLCA) report for 2010 patients • Results submitted to NECN, collated and analysed
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Number of Cases in Audit vs ExpectedTrust (N36) Number of Cases
Small CellSmall Cell Chemotherapy Rate
Expected Number in Audit
Number in Audit
RE9 12 50.0% 6
RLN 33 69.7% 10 8 (80%)
RNL 34 52.9% 16 9 (56%)
RR7 26 69.2% 8 7 (88%)
RTD 43 74.4% 11 9 (82%)
RTF 38 57.9% 16 8 (50%)
RTR 47 59.6% 19 15 (79%)
RVW 29 65.5% 10 7 (70%)
RXP 45 62.2% 17 17 (100%)
National 307 63.2% 113 80 (71%)
NECN 3,585 65.1% 2334
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Results
• Patient characteristics• Investigation• Treatment
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Median Age = 74 years (IQR 66-90)
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CT Performed and MDT Discussion
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Survivors >100 days vs All Patients
>100 days survival AllMedian Age (IQR) 78.5 (70-90) 74.0 (66-90)
M:F 5:11 (45%) 30:49 (38%)
Co-morbidity 14:2 (87.5%) 57/80 (71%)
Stage 3b,4 12/16 (75%) 69/80 (75%)
Performance Status 3,4 8/16 (50%) 51/80 (64%)
Chemotherapy discussed 14/15 (88%) 62/77 (81%)
Chemotherapy refused 7/10 (70%) 20/57 (35%)
Seen by Oncologist 10/16 (63%) 47/79 (60%)
Treated with radiotherapy 10/16 (63%) 22/47 (46%)
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Conclusions
• NLCA data collection is improving each year – Good quality comprehensive data important
• Process of audit is most valuable in reflecting on current practice– Surgical resection, histological confirmation, SCLC Chemotherapy
• Actual figures in audit are not the figures reported in NLCA – pre-upload review may significantly improve NLCA data values
• Almost all patients discussed at MDT meetings• Almost all patients had a CT
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Conclusions
• Median age was 74 years • Too many (44%) presented as emergencies vs 41% as 2WR• Too many had poor WHO PS – 64% WHO = 3 or 4• Significant Co-morbidity 71%• 81% Chemotherapy discussed with patient• 25% patients refused chemotherapy• 60% seen by oncologist• If no chemotherapy – about 25% had radiotherapy• Longer survivors – older, more co-morbidity, better WHO-PS
more likely to refuse chemotherapy
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Actions
• Review data before uploaded if possible• Ensure older patients with co-morbidity and better WHO – PS
have full discussion, offer of chemotherapy and review with oncology
• - Other suggestions?