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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 0  No mention of patients to be fast tracked in lung cancer clinical guidelines.

 No mention of a specific timeframe for diagnostic referral in suspected lung cancer

patients.

9 Guidelines/ pathways
for rapid referral to
quality care

0 – 2 1  No mention of rapid referral for lung cancer patients to secondary/ tertiary care in lung

cancer guidelines.

 Guidelines mention multidisciplinary teams guide treatment plans.

Lung cancer is at a crossroads

10 Medical and surgical
specialists

Number

per 100,000

unscored  In 2015:

4.21 pulmonologists

1.40 thoracic surgeons

15.48 general surgeons

5.7 oncologists.^10

11 Radiotherapy
accessibility

Number of

MVM; % unmet

need

unscored  -160 = 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 -58.8%.

 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 5  Histological and molecular testing is mentioned in lung cancer guidelines.

 EGFR and ALK are identified.

 EGFR, ALK and ROS1 approved and reimbursed.

 PD-L1 approved but not reimbursed, though anecdotally it may be reimbursed for patients

treated with first and second line immunotherapy.

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  Guidelines do not acknowledge psychological burden of lung cancer.

 No referral pathway to psychological support services is included in the guidelines for lung

cancer.

15 Patient access to
supportive / palliative
care services

0 – 2 1  Guidelines do not include a referral pathway to supportive / palliative care services for lung

cancer patients.

 Clinical oncologists have the option to specialise in palliative care. Anecdotally, supportive

/ palliative care knowledge is tested in final exams given to medical oncologists and

radiation oncologists.

Lung cancer is a focus for research

16 Clinical and outcomes
data collection

0 – 7 4  High quality population-based cancer registry (regional) (2 points out of possible 3).^11

 Low quality complete vital registration (2 points out of possible 4).^11

17 Research support and
funding

R&D as % of

GDP; ratio of

clinical trials

unscored  0.97% of GDP spent on research and development in 2016.

 Number of clinical trials between 2009-2018 = 304.^12

 The ratio of 2009-2018 clinical trials to GDP (billions) = 0.58.^13