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

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.”

This report was orignally published 10th April 2024. Version 2: May 2024 This version of the report includes the correction of typographical errors in the infographics on page 5, figures 2 and 3 on pages 7 and 12 and the final paragraph of the commentary on page 14

Read the full report: You can read the report by clicking on the link below.

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