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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:
4.7 pulmonologists
11.5 general surgeons
4 oncologists
No data on the number of thoracic surgeons.^8
11 Radiotherapy
accessibility

unmet need unscored  -28 = 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 -23.3%.
 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 3  Belgian practice guidelines state that EGFR, ALK and ROS1 testing are recommended
for lung cancer samples with at least one ADC component in patients with advanced or
recurrent disease.
 Specific markers are identified: EGFR, ALK and ROS1.
 EGFR is reimbursed in Belgium.
 ALK, ROS1 and PD-L1 are not currently reimbursed in Belgium.
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.
 While mentioned in the national cancer plan, the lung cancer guidelines do not mention a
referral pathway to psychological support services.
15 Patient access to
supportive / palliative
care services

0 – 2 1  While mentioned in the national cancer plan, the lung cancer guidelines do not mention a
referral pathway to supportive / palliative care services. However, the guidelines state that
“attention should be given to timely obtaining the patient's wishes (advance care planning)
with regard to the planning of care for advanced disease and for palliative care."
 ESMO curriculum includes many competencies on supportive measures, palliative care
and end of life care.
Lung cancer is a focus for research
16 Clinical and outcomes
data collection

0 – 7 6  High quality population-based cancer registry (PBCR) (national)
(3 points out of a possible 3).^9
 Medium quality complete vital registration (3 points out of a possible 4).^9
17 Research support and
funding

R&D as % of

GDP; ratio of

clinical trials

unscored  2.49% of GDP spent on research and development in 2016.

 Number of clinical trials between 2009-2018 = 297.^10

 The ratio of 2009-2018 clinical trials to GDP (billions) = 0.6.^11