Health Service Focus

13.01.20

NICE impact report says better public awareness of lung cancer could save countless lives

Professor Gillian Leng, deputy chief executive and health and social care director for the National Institute for Health and Care Excellence (NICE), discusses the latest impact report on lung cancer care.

Lung cancer is the leading cause of cancer death and the third most common cancer in England. According to the latest report by the Office for National Statistics, in 2017 there were almost 39,000 new cases of lung cancer and just over 28,000 deaths related to the disease. It should therefore be a priority for commissioners and providers to implement evidence-based guidance to correctly recognise, quickly refer, diagnose and treat lung cancer. The sooner we work together to achieve this, the quicker we will see improvements in survival rates and improved quality of life for those affected.

Since the publication of NICE’s first guideline on lung cancer in 2005, we have produced a suite of lung cancer related guidance, including 2 guidelines, 2 quality standards and 78 appraisals of new drugs to treat the condition. Our aim is to improve outcomes by ensuring the most innovative and cost-effective tests and treatments are carried out in the NHS.

Our latest impact report brings together our recommendations with nationally collected evidence and data, which tells us how our guidance is making a difference in priority areas of lung cancer care.

The impact report covers prevention, recognition, diagnosis, staging and treatment, as well as enhancing patient experience. It also identifies areas where improvement is needed.

Prevention and recognition

It is important that we challenge public misconceptions about the causes of lung cancer. It is estimated that 6,000 people who have never smoked die every year from lung cancer. The causes among non-smokers are difficult to pinpoint but have been linked to environmental factors such as air pollution.

NICE has published a guideline and quality standard that recommend ways local authorities and others can improve air quality through reduced emissions and initiatives such as clean air zones. This is mirrored in the NHS Long Term Plan which outlines plans to reduce the air pollution produced by the NHS by 2023/24.

Diagnosis and staging

The impact report discusses the importance of patients with suspected cancer being referred to a specialist quickly to diagnose the disease earlier. For the last 3 years the number of people referred to a specialist within 2 weeks of an urgent GP referral has remained at 96%. This shows that the fast track referral system for suspected cancer is working and NICE’s guidance can support GPs in the consultation room to make these important decisions.

NICE’s guideline on suspected cancer recognition and referral provides advice and guidance to healthcare professionals on the signs and symptoms of lung cancer which should trigger an urgent referral to a specialist. An online education platform, GatewayC, incorporating NICE’s recommendations in an interactive format, has been developed by The Christie NHS Foundation Trust to reinforce clinical decision making across a range of cancer courses.

Treatment and patient experience

The report also highlights the uptake of various treatment options for different stages and types of lung cancer recommended in our guidance. It is encouraging that data from the National Lung Cancer Audit shows an increase in surgery rates for people with stage 1 to 2 lung cancer from 52% in 2015 to 61% in 2017, which suggests that our guidance is being put into practice.

There are also a significant number of new medical therapies available for lung cancer, including second-generation targeted drug treatments. There is evidence to suggest that these new second-generation medicines are more potent, and result in prolonged progression-free survival. The impact report shows that during 2016 and 2017 uptake of second-generation drugs osimertinib and afatinib increased, whilst the use of first-generation drugs, erlotinib and gefitinib, declined.

It is vital that dignity and respect are integral to NHS cancer care. The impact report highlights the importance of having a named specialist nurse dedicated to all stages of lung cancer care. We recommend this in our guideline on the diagnosis and management of lung cancer, and between 2008 and 2017 there was a 15% increase in the number of people seen by a lung cancer nurse specialist (CNS). However, they still make up the lowest proportion of the cancer nurse specialist workforce, which therefore needs to be addressed.

Since the publication of NICE’s first guideline on lung cancer in 2005 and the beginning of full data collection by the National Lung Cancer Audit, there has been a steady increase in the number of people receiving active treatment and a notable improvement in 5-year survival rates.

More work is needed to achieve universal and timely access to high quality care delivered by a specialist team. With effective implementation of NICE-recommended treatments, we should be able to see improved outcomes in survival and quality of life for those affected by lung cancer.

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