Why we need to cut waiting times and improve lung cancer survival in Scotland - now.

Lung cancer continues to the be the deadliest cancer in Scotland, accounting for almost a quarter of all cancer deaths nationally in 2020.1

Despite improvements in quality of care and patient outcomes over the last ten years, nearly half (47.5%) of Scottish lung cancer patients are diagnosed with advance (stage IV disease)2 – and over a third are waiting more than 62 days from diagnosis to treatment.3 Currently, five-year survival is just 16% in Scotland3- well below the 21% now achieved in England.4

Delays in cancer care are clearly detrimental to patient outcomes. One key study has found that for every week treatment is delayed, there is a one percent decline in five-year survival.5

Shifting the dial on the number of people surviving the disease in Scotland is therefore vital. To do so, we need a combination of earlier diagnosis backed up by speedy treatment, which is why the new Scottish National Optimal Lung Cancer Diagnostic Pathway (SNOLCDP) – introduced at the end of 2022 - is so important.

We welcome the recent ambition of the Scottish Government and NHS Scotland to reduce current waiting times standards (to 42 days from 62).6 However, to have any chance of reaching this new target we need to need a rapid shift change in services now, to equip the new pathway so we can meet future patient demand. This is more important than ever because the accuracy of diagnosis and the range of effective treatments is expanding at an unprecedented rate meaning that if waiting times are too long even more patients will miss out on the chances of longer-term survival offered by these advances in care.    

Our new report Scottish Pathways Matter - compiled from input from health professionals and service providers working across 11 of the 14 Scottish Health Boards - provides an analysis of current lung cancer service provision and practice from the frontline. It also considers where gaps exist to achieving the new pathway, as well as identifying and sharing examples of best practice.

The result is a series of detailed recommendations for Health Boards, Regional Cancer Networks, NHS Scotland, and the Scottish Government’s consideration to improve and extend the lives of people living with a lung cancer diagnosis in Scotland.

These include:

  • Diagnosing lung cancer earlier by implementing targeted lung cancer screening in Scotland following the UK National Screening Committee recommendation and approval in England earlier this year.
  • Every lung cancer patient in Scotland having access to an offer of a CT scan within 72 hours of an abnormal chest x-ray.
  • An increase in imaging and in particular PET infrastructure and capacity in Scotland. 
  • Improved co-ordination and support for patients on the pathway - using cancer trackers, single points of contact (SPOC), lung cancer nurse specialists (LCNS), prehab, and bundles of investigations.

Some of these improvements can be achieved via innovation, rapid adoption of new technologies and supporting staff at a local level – while central funding and investment from the Scottish Government may be required for others e.g., molecular diagnostics.

We would like to extend our thanks to the three regional lung cancer clinical leads from each of the three Scottish cancer networks: Dr Melanie Mackean, Dr Richard Stretton and Dr Joris van der Horst, who led the development of this report.  

We hope that this report will provide the insight and impetus required for us to work together to shift the dial on the number of people surviving the disease in Scotland.

References

  1. Scottish Government 2022. Accessed July 2023: https://www.gov.scot/publications/scotlands-national-cancer-plan-report-progress-actions-31-august-2022/documents/
  2. Cancer Research UK. Early Diagnosis hub – proportion diagnosed by stage. Accessed July 2023: https://crukcancerintelligence.shinyapps.io/EarlyDiagnosis
  3. Public Health Scotland (2023). Cancer waiting times January-March 2023: unadjusted waits. Accessed August 2023: https://publichealthscotland.scot/media/20337/2023-06- 27-cwt-table-6-unadjusted-waits.xlsx
  4. Public Health Scotland (2022). Cancer survival statistics, People diagnosed with cancer during 2015 to 2019, Estimates of survival from lung cancer. Accessed August 2023: https://publichealthscotland.scot/media/13863/estimates-of-survival-from-lung-cancer.xlsx
  5. Sud, A. et al. Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study. doi: 10.1016/S1470-2045(20)30392-2 Accessed August 2023
  6. NHS Scotland Optimal Lung Cancer Diagnostic Pathway: https://www.nhscfsd.co.uk/our-work/earlier-cancer-diagnosis/diagnostics/optimal-cancer-diagnostic-pathways/nhs-scotland-optimal-lung-cancer-diagnostic-pathway