Indicator Range Score Justification
Lung cancer is a race against time
8 Suspected lung cancer
patient diagnosis within
a specific time frame
0 – 2 2 Lung cancer clinical guidelines state that suspected lung cancer patients should be offered
an urgent chest x-ray (performed within 2 weeks) if they are aged 40 or over if they have
two or more of the following unexplained symptoms or if they have ever smoked and have
one or more of the following unexplained symptoms: cough, fatigue, shortness of breath,
chest pain, weight loss, or loss of appetite. An urgent chest x-ray (within 2 weeks) in people
aged 40 or over with any of the following: persistent or recurrent chest infection, finger
clubbing, supraclavicular lymphadenopathy or persistent cervical lymphadenopathy, chest
signs consistent with lung cancer thrombocytosis.
9 Guidelines/ pathways for
rapid referral to quality
care
0 – 2 2 Lung cancer guidelines state that referral to secondary / tertiary care for treatment is to be
provided “without undue delay for people who have lung cancer that is suitable for radical
treatment or chemotherapy, or who need radiotherapy or ablative treatment for relief of
symptoms.” Furthermore, the guidelines state that arrangements are made “for people
with small-cell lung cancer (SCLC) to have an assessment by a thoracic oncologist within 1
week of deciding to recommend treatment.”
Lung cancer clinical guidelines state that everyone with a suspected diagnosis of lung
cancer is to be referred to a member of a lung cancer multidisciplinary team (usually a
chest physician).
Lung cancer is at a crossroads
10 Medical and surgical
specialists
unscored number
per 100,000 In 2016:
4.12 pulmonologists
1.53 thoracic surgeons
13.37 general surgeons
3.8 oncologists.^8
11 Radiotherapy
accessibility
unscored unmet need -281 is the difference between demand and supply of radiotherapy megavoltage machines.
(minus sign = deficit)^9
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 -46.9%.
Access to stereotactic radiotherapy (SABR) is limited in many areas.
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 Lung cancer guidelines mention histological and molecular testing.
Lung cancer guidelines mention EGFR, ALK, ROS 1 and PD-L1.
EGFR, ALK, ROS1 and PD-L1 approved and reimbursed.
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 specifically include psychological assessment or mention
the psychological burden of lung cancer.
However, the guidelines state that “other symptoms, including weight loss, loss of appetite,
depression and difficulty swallowing, should be managed by multidisciplinary groups that
include supportive and palliative care professionals.”
No referral pathway for psychological support services in lung cancer guidelines.
15 Patient access to
supportive / palliative
care services
0 – 2 2 Lung cancer guidelines discuss supportive and palliative care and state that care should be
provided by general and specialist palliative care providers in line with the NICE guidance
on improving supportive ad palliative care for adults with cancer.
Specific supportive and palliative care guidelines exist for all cancers.
Medical oncology specialty training includes competencies on supportive therapies and
palliative care which include management of pain, antiemetic agents, growth factors,
blood product support, nutritional support and rehabilitation.
Lung cancer is a focus for research
16 Clinical and outcomes
data collection
0 – 7 7 High quality population based cancer registry (national) (3 points out of a possible 3)^10
High quality complete vital registration (4 points out of a possible 4)
17 Research support and
funding
unscored R&D as % of
GDP; ratio of
clinical trials 1.69% of GDP spent on research and development in 2016.^11
Number of clinical trials between 2009-2018 = 502^12
The ratio of 2009-2018 clinical trials to GDP (billions) = 0.19