Lung cancer diagnoses via A&E ‘a travesty’ say experts

Emergency hospital admission is still the most common route for diagnosing lung cancer. This is ‘a travesty’, insists a new report published today (30^th January 2020).¹

According to the UK Lung Cancer Coalition (UKLCC), patients diagnosed via emergency are over five times more likely to die within one year of diagnosis than those referred for treatment by their GP.¹

“The UK has some of the worst lung cancer survival rates in Europe. This is because lung cancer is being diagnosed too late, often after an emergency presentation,’ says Professor Mick Peake, Clinical Director, Centre for Cancer Outcomes, and Chair of the UKLCC’s Clinical Advisory Group which authored the report.

In England, around 40 per cent of people with lung cancer first reach specialist care via an emergency admission to hospital.^2,3 In addition, across the country there is a five-fold variation in the proportion of lung cancers first diagnosed via an emergency.⁴

“Diagnosing lung cancer at an early stage can lead to more treatment options and better outcomes for patients,” adds Professor Peake.

According to the Office of National Statistics, nearly nine out of ten (88%) lung cancer patients will survive for at least a year if diagnosed early (stage 1), compared to only one fifth (19%) who are diagnosed with the most advanced stage of disease.⁵

The UKLCC’s report, ‘Early Diagnosis Matters: Making the Case for the Early and Rapid Diagnosis of Lung Cancer’, lays out 10 key recommendations for diagnosing lung cancer earlier in order to increase lung cancer survival. These include:

• The National Lung Cancer Audit (NLCA), which collects data on lung cancer treatments and outcomes, must continue uninterrupted and better define the nature and potential causes of variation at regional and local level.
• Public awareness and action campaigns focused on lung cancer should be funded every year – alongside regional and local campaigns to support improved understanding of signs and symptoms
• Stop smoking services should be encouraged to use their contact with smokers to increase awareness of the symptoms of lung cancer and the value of early detection
• The new 28-day cancer Faster Diagnosis Standard and National Lung Cancer Pathway must be comprehensively rolled-out across England
• The wider healthcare community, including nurses and pharmacists, must be able to refer someone who they suspect might have lung cancer for a Chest X-ray
• Clarity should be provided as to whose remit a lung cancer screening programme should fall under. The roll out of lung health checks must also be supported by effective processes with robust, nationally centralised data collection, collation and evaluation programme

The report also includes examples of best practice – demonstrating how certain NHS Trusts are working to make the earlier diagnosis of lung cancer happen.

“There is no single ‘silver bullet’ when it comes to increasing rates of early diagnosis in lung cancer. However, through consistent, wide ranging and coordinated efforts from across the lung cancer community, we can reduce late diagnosis, particularly through emergency presentation, and see a difference in the outcomes achieved across the UK,” says Mr Richard Steyn, chair of the UKLCC and Deputy Medical Director, University Hospitals Birmingham NHS Foundation Trust.

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Note to editors

About lung cancer

Lung cancer remains the UK’s biggest cancer killer, with over 35,000 deaths each year.⁵ The disease accounts for over a fifth of all UK cancer deaths (21 per cent) and one in seven (13 per cent) of all new UK cancer cases. ⁵ It is reported that four people die from lung cancer in the UK every hour (nearly someone every 15 minutes).⁵ Although the majority of cases of lung cancer are caused by smoking, it is estimated that ‘Lung Cancer in Never Smokers’ is the 8^th most common cancer in the UK⁶

About the UKLCC

The UK Lung Cancer Coalition (UKLCC) is the UK’s largest multi-interest group in lung cancer. It was set up in 2005 with the founding ambition of tackling poor lung cancer survival outcomes and, specifically to double five-year survival by 2015, which has now effectively been achieved.

The UKLCC has published numerous milestone reports including ‘25 by 25 – a ten-year strategy to improve lung cancer survival rates’ calling for governments, commissioners and healthcare community to work together to raise five-year lung cancer survival rates to 25 per cent by 2025. Its latest report ‘Pathways Matter’ is the first review of implementation of the National Optimal Lung Cancer Pathway. The UKLCC’s membership includes leading lung cancer experts, senior NHS professionals, charities and healthcare companies. www.uklcc.org.uk

References:

1. Early Diagnosis Matters, Making the Case for the Early and Rapid Diagnosis of Lung Cancer. UK Lung Cancer Coalition, January 2020. Available from 31 January 2020 at: uklcc.org.uk
2. Emergency presentation of cancer and short-term mortality. McPhail S, et al, Br J Cancer, 2013;109: 2027–2034. Available at: https://www.nature.com/articles/bjc2013569
3. Routes to Diagnosis, National Cancer Registration and Analysis Service. Available via: ncin.org.uk/publications/routes_to_diagnosis
4. Age-standardised rate of Emergency route to diagnosis for lung cancer by CCG in England, 2006-2015. National Cancer Registration and Analysis Service. Available at: https://www.cancerdata.nhs.uk/routestodiagnosis
5. Office of National Statistics, Cancer survival in England: national estimates for patients followed up to 2018, 2019. Available via: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/cancersurvivalinengland/stageatdiagnosisandchildhoodpatientsfollowedupto2018