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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 guidelines recommend that GPs ensure 80% of suspected patients should
be referred to diagnostic referral within 2 working days, at most 3 working days. 80% of
patients must complete the diagnostic process (CT scan, bronchoscopy, PET) within 3
weeks.
9 Guidelines/ pathways for
rapid referral to quality
care

0 – 2 2  Lung cancer guidelines recommend that pulmonologists ensure 80% of patients are
referred within 5 working days if there is evidence of a lung tumour or abnormalities in the
chest x-ray. Curative therapy should begin for 80% of patients within 2 weeks of diagnosis
and palliative therapy should begin for 80% of patients within 1 week of diagnosis.
 Multidisciplinary team referral mentioned to guide treatment plans and stated as being
indispensable in all phases of diagnosis and treatment.
Lung cancer is at a crossroads
10 Medical and surgical
specialists

number

per 100,000

unscored  In 2015:
5.12 pulmonologists
0.93 thoracic surgeons
9.73 general surgeons
No data on number of oncologists.^8
11 Radiotherapy
accessibility

unmet need unscored  -43 = 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 -25.3%.
 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 6  Lung cancer guidelines mention histological and molecular testing.
 Specific markers are identified: EGFR and ALK.
 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 1  Lung cancer guidelines include psychological assessment and mention the psychological

burden of lung cancer.

 Guidelines do not include a pathway to psychological support services.

15 Patient access to
supportive / palliative
care services

0 – 2 1  IKNL guidelines present a palliative care framework published in October 2017.
 Training in supportive / palliative care is not integrated into the training of oncologists in
the Netherlands.
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  2.03 of GDP spent on research and development in 2016.

 Number of clinical trials between 2009-2018 = 408.^10

 The ratio of 2009-2018 clinical trials to GDP (billions) = 0.49.^11