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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 2016:
4.71 pulmonologists
0.72 thoracic surgeons
7.60 general surgeons
1.5 oncologists.^9
11 Radiotherapy
accessibility

unmet need unscored  -193 = 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 -28.6%.
 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 2  In cases of locally advanced or metastatic non-small squamous cell carcinoma, molecular
testing is recommended.
 Specific markers are identified: EGFR and ALK.
 PD-L1 is reimbursed from national health insurance.
 EGFR, ALK and ROS1 are reimbursed from hospital budgets once the hospital’s annual
allocation has been used up.
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 of
psychological burden of
lung cancer and access
to support services

0 – 2 1  Lung cancer guidelines include assessment of a psychologist "according to need."

 Lung cancer guidelines do not mention a referral pathway to psychological support

services.

15 Patient access to
supportive / palliative
care services

0 – 2 1  Lung cancer guidelines mention a referral pathway to supportive / palliative care services.

 No evidence to demonstrate that oncologists receive training in supportive / palliative care.

Lung cancer is a focus for research
16 Clinical and outcomes
data collection

0 – 7 5  High quality regional 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  2.25% of GDP spent on research and development in 2016.

 Number of clinical trials between 2009-2018 = 609.^11

 The ratio of 2009-2018 clinical trials to GDP (billions) = 0.235.^12