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London Cancer Annual Engagement Event:
Unacceptable Lung Cancer Outcome Variation:
Wednesday 3rd June 2015
Sam Janes BSc MBBS FRCP MSc PhD
Vice-Chair of the Lung Cancer CRG NHS England
London Cancer Lung Pathway Director
5
10
15
20
1995-99 2000-02 2005-07
LUNG CANCER 5 YR R.S.
AUSTRALIA*
CANADA
SWEDEN
NORWAY
DENMARK
UK
Source: Coleman MP et al., Lancet. 2011;377:127-38
International Cancer Benchmarking Partnership: Comparative 5 yr relative survival 1995 - 2007
*Victoria and New South Wales only
Lung Cancer: stage distribution between ICBP nations
20.1% 19.6%14.0% 13.5%
Walters, et al. Thorax, 2013;68:551-564
The National Lung Cancer Audit
www.hscic.gov.uk
• Original DH funded RCP ‘snapshot’ audit 1996-8
• Data set published 1999• Intercollegiate Lung Cancer Group 1999• Funding from 2004 by NHS England’s
NCAPOP programme; first full year of data collection 2005
• England only 2005, UK roll out 2006• Mandated in England & Wales 2009• UK wide 2008• Jointly managed by the HSC Information
Centre and the Royal College of Physicians
Surgery in NSCLC (histologically-confirmed)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
%
14% 14% 15% 16% 19% 18% 21% 22% 23%
23%overall
A RESECTION RATE OF <10% IS
REPORTED
IN 14 ENGLISH TRUSTS
Surgery
Anti-Cancer Treatment
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
%
45% 50% 52% 54% 59% 59% 61% 61% 60%
60%overall
ANTI-CANCER TREATMENT IS GIVEN
TO <50%
IN 15 ENGLISH TRUSTS
Active treatment
One year survival
Source: Lucada
Primary lung cancer resections (n=122,408)
Source: R Page & Doug West, Society of Cardiothoracic Surgeons Audit 2013
0
19
80
Calendar years
2,000
3,000
4,000
5,000
6,000
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
1,000
Financial years
Year of surgery
Nu
mb
er
of
pro
ced
ure
s
National Lung Cancer Auditfirst report
20
11
6360
Survival improvements in Mount Vernon Cancer Network
Source: Greenberg, Lok, et al; BTOG, January 2012
0
50
100
150
200
250
300
350
400
450
500
550
600
650
n
Number of cases by Trust 2012 (LUCADA)
HHWX
NH
Barts
BHR
PAH NMH
BCF
RFH
WHUCH
The Board focussed on three elements
Pathway specification
Early diagnosis
Other immediate
work
Our vision is that we can increase the number of treating physicians in MDTs offering patients indirectly more opinions and options and that the majority of London Cancer patients being treated in outer London Hospitals have the same opportunities as those in central London teaching hospitals.
Headlines from pathway specificationTo increase expertise at key decision points in the pathway, thereby reducing variation in practice:
•Creating larger MDTs to increase the clinical expertise present for the review of every patients’ case
•Diagnosis and staging MDTs to ensure all patients are offered the most appropriate investigations
•Decision to Treat MDTs
• 53,454 enrolled• 3 annual LDCT vs CXR• 20% reduction in lung cancer specific
deaths in CT arm (6.4% reduction all cause mortality)
CT Screening in London
Will be approaching around 2000 individuals
Expecting around 600 scans
It’s a start!
London Cancer Annual Engagement Event:
Delivering the national vision for improving outcomes in colorectal
cancer:Wednesday 3rd June 2015
Michael Machesney BSc MBBS FRCS(Eng) FRCS (Gen) MD
Chair of the Colorectal Cancer CRG NHS England
London Cancer Colorectal Pathway Director
Delivering Value Based Healthcare
Value = patient derived outcome/ cost of whole pathway
“if we were where you are now, we wouldn’t do what you’re about to do” City Hall, London 29th February 2012
Professor Michael Porter
Commissioning for Bowel Cancer
‘
Colorectal Cancer Clinical Reference Group
Reviewing the whole colorectal cancer pathway producing a service specification for commissioners
1
Clinical Reference Groups for Specialised Services A Guide for Clinicians
Colorectal Cancer Clinical Reference Group
Early diagnosis
Safer treatment
Improving follow-up
Forward View
‘faster diagnosis for cancer’
‘We will expand access to
screening’
Reducing unwarranted variation:Diagnosis
Colorectal Cancer Clinical Reference Group
Early diagnosis
Safer treatment
Improving follow-up
Reducing unwarranted variation:Survival 1 year
Forward View‘more uniform treatments for cancer’
‘ access to world-leading facilities for their surgery and radiotherapy’
‘in Denmark reducing by two thirds the number of hospitals that perform colorectal cancer surgery has improved post-operative mortality after 2 years by 62%’
Localise where possible,centralise where necessary
Cancer care offers a good example of how current decentralised services are simply not good enough
Ara Darzi July 2007
Colorectal Cancer Clinical Reference Group
Early diagnosis
Safer treatment
Improving follow-up
Forward View
‘patients to have chemotherapy,
support and follow up care in their
local community hospital or primary
care facility’
Reducing unwarranted variation:Survival 5 years
Questions?
