Pathway navigator ‘critical’ to cutting lung cancer waiting times say experts

An admin role, described as ‘critical’ in helping to cut lung cancer waiting times and speeding up diagnoses, continues to face national funding challenges says a new report published today (18 October 2019) by the UK Lung Cancer Coalition (UKLCC).¹

According to Pathways Matter – the first report to track uptake of NHS England’s National Optimal Lung Cancer Pathway [NOLCP] guidance and identify barriers – the appointment of a patient pathway navigator can help to more than double the number of lung cancer patients receiving treatment by day 49.¹ 

However, securing funding for the role remains ‘challenging’, according to interviews among 17 of the 19 Cancer Alliances.¹

“The introduction of the patient pathway navigator has been singled out by our research as one of the most impactful and cost-effective changes made as part of NOLCP implementation,” says Professor Mick Peake, Chair of the UKLCC’s Clinical Advisory Group. “Yet our research shows not all Cancer Alliances or trusts have been able to secure funding to support the role – and, those that have, have either not been able to maintain the post or face uncertainty due to a lack of sustainable funding.”

The NOLCP was introduced by NHS England in 2017 to get lung cancer patients diagnosed faster and cut treatment times from the current standard of 62 days to 49 and is welcomed by the UKLCC.²

Despite improvements in quality of care and patient outcomes over the last ten years, around half (48%) of UK lung cancer patients are still diagnosed within the late stages of the disease – and a third are not being treated within the current 62-day cancer waiting time target.¹

“Delays in timely diagnosis and associated patient access to treatment and care have been identified as contributing to the UK’s comparatively low lung cancer survival compared with the rest of Europe,” adds Professor Peake. “Our report highlights that appointing an administrator to manage the lung cancer pathway, which involves no clinical knowledge, is one of the important ways we can speed up the patient’s journey and improve lung cancer survival. It’s an absolute no-brainer.”

The cost of a lung cancer pathway navigator post ranges, on average, from just £20,000 to £25,000 per annum.³ As well as tracking appointments, rescheduling missed ones and chasing test results, pathway navigators provide an invaluable central point of contact for anxious patients and their families.^1,4

Going forward, the report suggests more ‘economic’ modelling to assess the positive impact of the pathway navigator on patient survival.¹

Other key recommendations within the report, also aimed at ensuring uptake of the NOLCP, are:¹

• Introducing a central PET-CT scan booking system to ensure timely access to the limited number of PET scanners in a given geographic area. Currently, the UK has less than half the number of PET scanners those available in other comparable, EU countries e.g. Italy has 185 PET-CT scanners compared to just 78 in the UK.
• Direct referral by a radiologist of any suspicious chest x-rays for immediate, further investigation – rather than returning to the patient’s GP for next steps which can slow down the pathway.
• Ensure chest X-rays and CT images are available before the diagnostic MDT meeting. This can reduce the patient’s pathway by as much as 14 days.
• Speed up pathology times e.g. by introducing a simple colour-coding system to indicate which lung cancer samples are urgent. Some Cancer Alliances interviewed for the report identified significant backlogs on the system with one Alliance detecting tissue samples crossed up to 21 hands within the pathology pathway, thus increasing the risk of delays or samples being lost in the system.

“If we were to significantly increase the proportion of patients diagnosed at an early stage of their disease and at the same time ensured that every patient treated within the NHS received optimal and timely treatment, we believe that by 2025 we could see 25% of patients in the UK living to five years and beyond,” says Richard Steyn, chair of the UKLCC.

To download a copy of the Pathways Matter report, please visit www.uklcc.org.uk:

About the report

The development of the report was informed by comprehensive desk research and literature review of key websites, portals and publications. To assess the progress achieved by Cancer Alliances across the country as well as the barriers they encountered in the implementation of the NOLCP, semi-structured interviews were carried out with 17 out of 19 NHSE Cancer Alliances, as well as the following experts:

• Professor Sir Mike Richards, former National Cancer Director and current Cancer Screening Programme Review Lead
• Professor David Baldwin, Chair of NHS England’s Lung Clinical Expert Group
• Lorraine Dallas, Director of Information, Prevention and Support at the Roy Castle Lung Cancer Foundation
• Dr Martin Allan, Clinical Lead for the respiratory workstream, Getting It Right First Time (GIRFT)

The interviews were carried out from April to September 2019.

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 UKLCC is the UK’s largest multi-interest group in lung cancer and was established to help bring lung cancer out of the political, clinical and media shadow.  Its membership includes leading lung cancer experts, senior NHS professionals, charities and healthcare companies.  Its charity members include the British Lung Foundation, Tenovus Cancer Care, Macmillan Cancer Support, Marie Curie Cancer Care, Roy Castle Lung Cancer Foundation, and Cancer Black Care. Please visit www.uklcc.org.uk for more information and details of all of the UKLCC partners.

References

1. Pathways Matter: A review of the implementation of the National Optimal Lung Cancer Pathway. UK Lung Cancer Coalition, October 2019. Available at uklcc.org.uk
2. National Optimal Lung Cancer Pathway – updated 2018? https://www.england.nhs.uk/wp-content/uploads/2018/04/implementing-timed-lung-cancer-diagnostic-pathway.pdf
3. Based on interviews with Cancer Alliances and access to recruitment websites
4. NHS England, Patient Navigators, accessible at: https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2016/12/patient-navigators.pdf
5. ‘Lung cancer in never-smokers: a hidden disease’ accessed at: https://journals.sagepub.com/doi/full/10.1177/0141076819843654