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Indicator Range Score Justification

Lung cancer is at a crossroads

10 Medical and surgical
specialists

Number

per 100,000

unscored  In 2015

5.47 pulmonologists

1.78 thoracic surgeons

11.39 general surgeons

3.9 oncologists.^9

11 Radiotherapy
accessibility

Number of

MVM; % unmet

need

unscored  -134 = the difference between demand and supply of radiotherapy megavoltage machines.

(minus sign = deficit)

 There is an insufficient supply of radiotherapy megavoltage machines in relation to

demand.

 Percent of unmet need between observed and expected number of radiotherapy

megavoltage machines is -35.8%.

 No data available to assess the length of time a lung cancer patient must wait in order to

access radiotherapy treatment.

12 Tumour testing
recommendations and
accessibility

0 – 6 6  Histological and molecular testing is mentioned in the guldelines.

 Specific markers are identified: EGFR, ALK and ROS1 are specifically identified in the lung

cancer guidelines.

 Tests are reimbursed and approved: EGFR, ALK, ROS1 and PD-L1.

13 Key personalised
medicines
reimbursement and
accessibility

0 – 10 10  All five of the tyrosine kinase inhibitors and anti PD1 antibodies we studied are registered

and available for the majority of patients through the health system.

14 Understanding
psychological burden of
lung cancer and access
to support services

0 – 2 0  Lung cancer guidelines do not include psychological assessment or mention the

psychological burden of lung cancer.

 No referral pathway to psychological support services in lung cancer guidelines.

15 Patient access to
supportive / palliative
care services

0 – 2 1  No referral pathway mentioned in lung cancer guidelines.

 Palliative care training is part of the undergraduate education curriculum in medical

schools in Spain.

Lung cancer is a focus for research

16 Clinical and outcomes
data collection

0 – 7 5  High quality population-based cancer registry (PBCR) (regional)

(2 points out of a possible 3).^10

 Medium quality complete vital registration (3 points out of a possible 4).^10

17 Research support and
funding

R&D as % of

GDP; ratio of

clinical trials

Unscored  1.19% of GDP spent on research & development in 2016.

 Number of clinical trials between 2009-2018 = 595.^11

 The ratio of 2009-2018 clinical trials to GDP (billions) = 0.45.^12