Improvements in MDT performance ‘too slow’ say experts

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Poor progress in some areas of multidisciplinary team (MDT) working is hindering patient treatment and survival, says a new report launched today (18 December 2014) by lung cancer experts.1

According to the UK Lung Cancer Coalition (UKLCC), lung cancer MDTs are not performing well in some key areas and large numbers of patients are still not being diagnosed early enough.

“The number of patients being diagnosed with stage IIIB or IV lung cancer varies from 11 percent to 76 percent across England,” says Dr Mick Peake, Chair of the UKLCC’s Clinical Advisory Group and Clinical Lead, National Cancer Intelligence Network and National Lung Cancer Audit.  “Such a high variation cannot continue if lung cancer patients are to be given the best possible chances of receiving appropriate and effective treatment.”

As well as tracking progress made since the launch of the ‘TheDream MDT for lung cancer’ published in 2012 - the report maps out 12 new priorities for the future.*

“Nearly one-third of lung cancer patients have to see their GP three times or more  before being referred to hospital; a figure which has shown no improvement in the last year,” adds Dr Peake. “We are calling for GPs to ensure that patients with signs and symptoms of lung cancer are urgently referred through the two week wait pathway. The earlier we diagnose lung cancer, the more likely patients can be treated and survive.”

The comprehensive review collates views and insights from active lung cancer MDT members across the country and analyses data on MDT performance from the most recently published National Cancer Patient Experience Survey (NCPES), National Lung Cancer Audit (NLCA), and Lung Cancer Service Profiles (LCSP).

Lung cancer continues to be the UK’s biggest cancer killer.2 There are over 35,000 deaths every year2 which amounts to a greater death toll than breast cancer, prostate cancer, bladder cancer, stomach cancer and leukaemia combined.3   It is reported that four people die from lung cancer in the UK every hour.2

Despite improvements in services in recent years, wide variations in lung cancer treatment and care continue to persist across the UK and treatment and survival rates lag behind other comparable countries in Europe.4,5 Patients in the UK are diagnosed with more advanced disease than many other countries and almost 40% first reach specialist care via an emergency admission to hospital.,6

TheUKLCC’S vision is to double lung cancer survival during the next six to ten years, with the co-operation of health professionals, policy makers, local primary care organisations, the NHS and Government. 

“Multi-disciplinary teams are at the heart of delivering improved outcomes for lung cancer patients, yet some aspects of MDT working still require drastic improvement across the country,” says Mr Richard Steyn, Chair of the UKLCC and Consultant Thoracic Surgeon and Associate Medical Director, Surgery, at the Heart of England NHS Foundation Trust.

“Only through continual monitoring, evaluation and service improvement will all patients receive the treatment they both need and deserve.”

The UKLCC plans to undertake a further review of lung cancer MDTs in 2016 and annually thereafter.

For a copy of ‘A review of The Dream MDT: Measuring and improving high quality lung cancer outcomes’ please visit:  www.uklcc.org.uk

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Note to editors

The UK Lung Cancer Coalition (UKLCC) is the UK’s largest multi-interest group in lung cancer.  It believes that by applying the best standards already being demonstrated in the best lung cancer centres in Europe, 3,500 lives could be saved each year in the UK.

*The 12 recommendations outlined in the ‘Review of ‘The Dream MDT’:Measuring and improving high quality lung cancer outcomes’ are as follows:-

1.       MDTs should ensure the lung CNS to lung cancer patient ratio is adequate to allow CNSs to be a core part of the MDT and be available for diagnostic, treatment and end of treatment appointments for all patients

2.       GPs should ensure patients with signs and symptoms of lung cancer are urgently referred through the two week wait pathway, and proactively follow up with their patients to ensure they have received diagnostic tests and fully understand the information given to them

3.       GPs should be regularly informed as to where their patients are along the care pathway and GPs should work with the MDT to ensure patients are told why they have been referred and be provided with information about their condition and treatment options

4.       Patients with suspected lung cancer should be assessed at a dedicated rapid access clinic at the earliest possible opportunity. In addition, the diagnostic pathway should be designed by the MDT to encourage use of fewer, but higher value, tests to increase the likelihood that diagnosis and stage of the disease is assigned as quickly and effectively as possible

5.       Full and appropriate membership of the specialist team and their regular attendance at the meetings should be of paramount importance to each MDT

6.       MDTs should ensure patients are provided with written information about the type of cancer they have as soon as a diagnosis has been established and ensure the patient fully understands the information given to them and has an opportunity to ask any questions they may have

7.       All MDTs for lung cancer patients should have at least one thoracic surgeon (undertaking a minimum one full day thoracic operating, minimum one full MDT per week and a thoracic surgical outpatient clinic with CNS support) as a core member

8.       MDTs should work to ensure all patients are given appropriate treatment options before they begin their treatment regime and are fully involved in decisions about their care

9.       MDTs should ensure all lung cancer patients are given information about any possible side effects of treatment in an easy to understand format

10.    MDTs should always arrange a ‘stock-take’ meeting within a maximum of one month from the end of a patient’s treatment to assess their experience of the care pathway, determine any other treatment provision and provide assurances of possible next steps

11.   As a minimum, MDTs should routinely assess patients’ supportive and palliative care needs around the time of diagnosis, on completion of primary treatment, when there is significant deterioration of symptoms and when it becomes clear that a patient is nearing death. A particular focus should be on improving the information required by patients and carers to ensure there is appropriate ongoing support at home

12.   At each stage of the care pathway the MDT should assess if a patient is eligible for a clinical trial and, if so, ask the patient whether they would like to participate

References

1.        Review of ‘The Dream MDT’:Measuring and improving high quality lung cancer outcomes. UKLCC December 2014

2.        Figures from Cancer Research UK, accessed December 2014 at:  http://www.cancerresearchuk.org/cancer-info/cancerstats/types/lung/mortality/

3.        Figures from Cancer Research UK accessed December 2014 at: http://www.cancerresearchuk.org/cancer-info/cancerstats/mortality/cancerdeaths/#Twenty

4.        National Lung Cancer Audit Report 2014. Report for the audit period 2013. Accessed December 2014 at: http://www.hscic.gov.uk/catalogue/PUB16019

5.        Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5 - a population based study. De Angelis R et al.  The Lancet Oncology.  2014; 15 (1): 23-34

6.        Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets.  Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, Richards M. Br J Cancer. 2012, 107(8):1220-6      

For further information, please contact Lynsey Conway on 07778 304233

For further information about the UKLCC and its partners, visit www.uklcc.org.uk

UKLCC Secretariat, c/o Red Hot Irons Ltd info@uklcc.org Telephone: 01675 477 605 Facsimile: 0121 336 1914