IMPROVING CURATIVE-INTENT TREATMENT RATES IN EARLY STAGE LUNG CANCER - RESULTS FROM 775 PATIENTS IN THE NLCA SPOTLIGHT AUDIT

Background One possible explanation for poor survival in lung cancer patients in the UK is under-utilisation of curative-intent treatment. We carried out a spotlight audit to understand why eligible patients do not receive surgical treatment and whether national guidelines for assessment of early-stage lung cancer were being adhered to. Methods Details of patients in England with stage I/II NSCLC and a performance status of 0–1 who did not undergo surgical treatment were extracted from the NLCA dataset and used to populate a web-based portal developed in conjunction with the National Cancer Registration and Analysis Service (NCRAS). Trusts were invited to populate their cases with additional data. Results 82 of 142 trusts in England took part in the audit and data on 775 patients was suitable for analysis (67% stage I and 33% stage II). 46% of patients did receive treatment with curative intent in the form of SABR or radical radiotherapy (including CHART). 8% received other anti-cancer therapy, and 46% received best supportive care. As expected, age over 75 independently predicted best supportive care, even after other factors associated with age (such as co-morbidity and PS) are taken into account. 31% of patients did not have surgery owing to patient choice and, of these, 66% preferred SABR or other radical radiotherapy, while the remainder elected for no treatment. Only 2% of patients had a second surgical opinion, 14% had a CPEX, 34% had an echocardiogram and 11% had a V/Q scan. Very few patients had a shuttle walk test, or had thoracoscore or a formal cardiac risk assessed. 1 year survival for patients having best supportive care was 37%, for SABR it was 67%, for radical radiotherapy it was 45% and for those undergoing palliative radiotherapy was 27%. After adjustment for age, PS, stage, deprivation index and comorbidity index (ACE-27), both SABR and radical radiotherapy improved survival compared with best supportive care. Conclusions Although nearly half the patients did receive an alternative treatment with curative intent, patient choice is a common reason for not receiving surgery. It is crucial that patients are assessed according to best practice and that information about their options is delivered and discussed appropriately.