National Lung Cancer Audit (NLCA) State of the Nation report

HQIP – 10th April 2024

The National Lung Cancer Audit (NLCA), which is part of the National Cancer Audit Collaborating Centre (NatCan), has published a new report on the care received by patients diagnosed with lung cancer in England and Wales during 2022. It found that curative treatment rates for patients with early-stage lung cancer have been maintained (at 78% in England; 76% in Wales), despite the growth in demand due to an increase in early-stage presentations. More specifically, the proportion of patients diagnosed with stage I/II lung cancer has increased; in England, the proportion rose to 33.8% in 2022 compared to 30.5% in 2021 and 30.2% in 2019.

However, the report also states that several areas of care require significant improvement. Unlike most treatment metrics, the proportion of patients who had a lung resection has still not returned to pre-pandemic levels, although more patients had surgery in 2022 than 2021. Bed capacity issues may have been a contributing factor to this indicator not yet returning to 2019 levels and, as such, a call is made for providers to ensure that they have capacity to meet both current and future demand.

Other findings include:

• Time from diagnosis to treatment has worsened (in England, the median time was 41 days)
• Performance could be improved in relation to patients with stage IIIA non-small cell lung cancer (NSCLC) and good performance status being offered curative intent treatment, as well as for patients with advanced disease and good performance status receiving systemic anti-cancer therapy
• A third of patients are still being diagnosed after presenting via the emergency route, and there is marked geographical variation in these rates.

This report goes on to state that data completeness also requires improvement, particularly ‘smoking status’, and ‘seen by lung cancer CNS’ in the English Rapid Cancer Registration Dataset. It also underlines the importance of NHS trusts using the ‘route to diagnosis’ data item to record patients diagnosed after screening by the targeted Lung Health Check (TLHC) programme, saying: “Good quality data on the route to diagnosis is essential for the impact of screening on outcomes to be evaluated.”

Read the report – National Lung Cancer Audit (NLCA) State of the Nation report

Computed Tomography Colonography And Lower Gastrointestinal Cancer Pathways Planning For The Next Decade

RCR – Winter 2023

This document represents a vision for future development of NHS CTC services and has been produced as a multidisciplinary collaboration between the British Society of Gastrointestinal and Abdominal Radiology (BSGAR), The Royal College of Radiologists (RCR), the Society and College of Radiographers (SCoR), the Gastro Intestinal Radiographers Special Interest Group (GIRSIG) and other stakeholders including the National CT Colonography Training and Accreditation Programme and the Association of Coloproctology of Great Britain and Ireland (ACPGBI).

It outlines the key components required of CTC services to meet the needs of patients and clinicians in primary and secondary care and highlights the referral pathways, quality assurance, leadership, organisation and resource requirements necessary to deliver a better patient experience and outcomes. Its intention is to outline the necessary components to build a uniform provision of high-quality CTC services across the NHS in England for patients.

RCR Publications Computed Tomography Colonography And Lower Gastrointestinal Cancer Pathways Planning For The Next Decade January 2023

Alcohol Consumption Among Adults With a Cancer Diagnosis in the All of Us Research Program

JAMA Netw Open. 2023;6(8)

Key Points

Question  What is the prevalence of current alcohol consumption and of risky alcohol consumption among cancer survivors in the US?

Findings  In this cross-sectional study of 15 199 adults with a cancer diagnosis from the All of Us Research Program, 77.7% self-reported as current drinkers, and among these, 13.0% exceeded moderate drinking, 23.8% reported binge drinking, and 38.3% engaged in hazardous drinking. Among 1839 survivors receiving cancer treatment, the prevalence of current drinking and risky drinking were similar to the overall cohort and across treatment types.

Meaning  This study suggests that current drinking and risky drinking are common among US cancer survivors even during cancer treatment.

Further information – Alcohol Consumption Among Adults With a Cancer Diagnosis in the All of Us Research Program

Small amounts of exercise protect against early death, heart disease and cancer

NIHR – August 2023

Even half the recommended amount of exercise may reduce the risk of early death, diseases of the heart and blood vessels (cardiovascular disease), and cancer. Research suggests that an hour and a quarter per week (11 minutes per day) of moderate-intensity exercise can lower risk of these outcomes, compared with no exercise. The analysis supports the recent change to UK public health messaging that ‘some exercise is better than none.’

Researchers analysed 196 research articles (involving more than 30 million adults in total) about the health benefits of exercise. They found reductions in the risk of early death, cardiovascular disease, and cancer with increasing amounts of exercise (up to 5 hours per week). They estimated that 1 in 10 early deaths could be prevented if everyone did at least an hour and a quarter of moderate-intensity exercise per week.

The researchers recommend that people do whatever exercise they can because even small amounts are linked with health benefits.

Further information – Small amounts of exercise protect against early death, heart disease and cancer

This Alerts is based on: Garcia L, and others. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies. British Journal of Sports Medicine 2023; 57: 1 – 15. 

Breast cancer mortality in 500 000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study

BMJ 2023

Objectives To describe long term breast cancer mortality among women with a diagnosis of breast cancer in the past and estimate absolute breast cancer mortality risks for groups of patients with a recent diagnosis.

Design Population based observational cohort study.

Setting Routinely collected data from the National Cancer Registration and Analysis Service.

Participants All 512 447 women registered with early invasive breast cancer (involving only breast and possibly axillary nodes) in England during January 1993 to December 2015, with follow-up to December 2020.

Main outcome measures Annual breast cancer mortality rates and cumulative risks by time since diagnosis, calendar period of diagnosis, and nine characteristics of patients and tumours.

Results For women with a diagnosis made within each of the calendar periods 1993-99, 2000-04, 2005-09, and 2010-15, the crude annual breast cancer mortality rate was highest during the five years after diagnosis and then declined. For any given time since diagnosis, crude annual breast cancer mortality rates and risks decreased with increasing calendar period. Crude five year breast cancer mortality risk was 14.4% (95% confidence interval 14.2% to 14.6%) for women with a diagnosis made during 1993-99 and 4.9% (4.8% to 5.0%) for women with a diagnosis made during 2010-15. Adjusted annual breast cancer mortality rates also decreased with increasing calendar period in nearly every patient group, by a factor of about three in oestrogen receptor positive disease and about two in oestrogen receptor negative disease. Considering just the women with a diagnosis made during 2010-15, cumulative five year breast cancer mortality risk varied substantially between women with different characteristics: it was <3% for 62.8% (96 085/153 006) of women but ≥20% for 4.6% (6962/153 006) of women.

Conclusions These five year breast cancer mortality risks for patients with a recent diagnosis may be used to estimate breast cancer mortality risks for patients today. The prognosis for women with early invasive breast cancer has improved substantially since the 1990s. Most can expect to become long term cancer survivors, although for a few the risk remains appreciable.

Further information – Breast cancer mortality in 500 000 women with early invasive breast cancer in England, 1993-2015: population based observational cohort study

Cancer strategy for Scotland – 2023-2033

Scottish Govt – June 2023

This Cancer strategy for Scotland sets out our vision for the next ten years to improve cancer survival and provide excellent, equitably accessible care. It was developed in collaboration with people with lived experience and our wider partners.

Further information – Cancer Strategy for Scotland 2023-2033

Inquiry into radiotherapy and the cancer crisis

T H E APPG F O R RA D I O T H ERAPY – 2023

This is the second inquiry undertaken by the APPG on Radiotherapy. The first inquiry took place in 2019
before the Covid pandemic and investigated radiotherapy provision’s ability to meet demands of that
time and anticipated future need.

Read the Report – Inquiry into radiotherapy and the cancer crisis

Urology: towards better care for patients with kidney cancer

Getting It Right First Time – 2023

This guidance, a collaboration between Getting It Right First Time, the British Association of Urological Surgeons and the British Association of Urological Nurses, describes the key features of a good kidney cancer service and lists the quality actions teams can take to bridge any gaps they identify. It also includes a delivery checklist and case studies illustrating good practice.

Further information – Urology: towards better care for patients with kidney cancer

Listening to Cancer Patients’ Narratives During Residency: A Pilot Study on a Communication Skills’ Workshop Involving Patients-Partners

 Journal of Patient Experience. 2023

The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient’s narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants’ reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.

Read the article – Listening to Cancer Patients’ Narratives During Residency: A Pilot Study on a Communication Skills’ Workshop Involving Patients-Partners

ALL THINGS BEING EQUAL? Inquiry into cancer inequalities in Wales caused by socio-economic deprivation

Cross Party Group on Cancer – June 2023

In October 2022, the Cross-Party Group for Cancer launched an inquiry into inequalities and cancer
in Wales. The Group sought to gather evidence from policy and health experts, to hear from leaders
in understanding and reducing poverty and inequalities, and to understand the needs of people in
deprived communities across Wales who have been affected by cancer.
While cancer inequalities can exist for a range of different demographic groups, this inquiry focused
on the impact of deprivation and geography on inequalities as this is where the data are strongest.
This does mean that we do not have as clear a picture, or strong recommendations, on cancer
inequalities due to ethnicity, sex, gender identity, sexual orientation or disability.
The Group received oral evidence at 3 sessions, where we heard from 8 witnesses, followed by a
call-out for written evidence where we had 21 responses. We surveyed people affected by cancer,
through the Cancer Research UK Involvement Network and through Tenovus Cancer Care’s All Wales
Cancer Community.
This final report sets out the evidence we received, identify where and how inequalities exist across
the cancer pathway in Wales, and provide actionable recommendations.
Aims of the inquiry

• Understand the impact that inequalities, and particularly deprivation, have on patient
  experience, access to cancer services, cancer incidence and cancer outcomes in Wales.
• Provide recommendations to the Welsh Government, NHS Wales, and other public bodies to
  tackle inequalities across the cancer pathway, and in particular the impact of poverty and
  deprivation on patient access and experience.

Read the Report – Inquiry into cancer inequalities in Wales caused by socio-economic deprivation