Lung cancer in England: Information from the National Lung Cancer Audit (LUCADA)☆
Introduction
Outcome measures for lung cancer in the UK are worse than those in comparable European and North American countries [1], but the reasons for this are unclear. The National Lung Cancer Audit (NLCA) was established in 2004 to identify possible inequalities within the National Health Service (NHS) and highlight the potential for service improvements.
The NLCA database (LUCADA) is a record of detailed clinical information of individuals diagnosed with lung cancer in England and Wales. As such it is a unique dataset, offering more detailed information on lung cancer patients than the large registry linked datasets of both Europe (EUROCARE-4) and America (SEER, Surveillance Epidemiology and End Results programme) [2]. NHS Trusts are requested to upload information on all lung cancer patients, but data entry is non-mandatory and this has raised concerns about the validity of the database because of the potential bias which could arise if patients were ‘selected’ for inclusion in the audit.
The aims of this study were two-fold; firstly to determine whether demographic and outcome data from individual NHS Trusts held in LUCADA are influenced by the level of data completeness; and secondly to describe the features of people with lung cancer currently in England and to determine whether the socio-economic status of an individual with lung cancer contributes to either the treatment they receive or their overall survival.
Section snippets
Data entry into LUCADA
Data entry into LUCADA in England began in November 2003 and takes place via the 157 NHS Trusts across the country responsible for diagnosing and treating patients with lung cancer. Financial support for NHS Trusts comes from the Department of Health via the 152 primary care trusts that commission services from general practitioners (GPs) and NHS Trusts within their geographical area.
Data entry follows a pro-forma which can be accessed on line at; //www.ic.nhs.uk/webfiles/Services/NCASP/Cancer/New%20web%20documents%20(Lung)/LUCADA%20proforma%20v3%20+%20Key%20Fields.doc
Results
Our LUCADA dataset contained a total of 67,824 patients at English NHS Trusts with their first hospital attendance before 1st January 2008. We excluded 4038 patients (6%) as it was not possible to assign a “start” date. A further 3727 patients (5.5%) were removed as they failed to have either an NHS Trust assigned (3039), or an NHS Trust that could be linked to Registry data (688), primarily because of changes in infrastructure over time. This left 60,059 patients for analysis: 21,976 from
Principle findings
We have found that despite variation in the NHS Trust level of case ascertainment within the LUCADA dataset, there was little variation related to this in patient demographics, access to treatment and survival. This suggests that overall the data within LUCADA are unbiased and are representative of people with lung cancer in England.
We found that although only a minority of patients undergo surgery, for the subgroup of patients with proven non-small cell lung cancer this figure is 14%, which is
Comparison with other studies
Whilst there are few published national studies of health service research involving lung cancer in England, there have been smaller audits at a regional level which have described geographical variation in treatment and survival for people with lung cancer [6], [7]. Jack et al. [6] found that a deprived socio-economic status was linked to a reduced likelihood of receiving chemotherapy, but that it had no impact on 1- or 3-year survival, findings consistent with our own results. In 1998 an
Implications of this study
The implications of this study are two-fold; firstly the validation of the LUCADA dataset on the basis of data completeness suggests that these data reflect the current state of lung cancer in England. As such, it is a unique dataset which has enormous potential to inform and influence policy change and to improve the standard of care for lung cancer patients.
Secondly these analyses provide contemporary estimates of treatment received and overall survival in people with lung cancer in England,
Conflict of interest
None.
Acknowledgements
The authors would like to thank the trustees of the Royal College of Physicians of London in funding this programme of analysis and Dr H MØller, Thames Cancer Registry, for sharing the data on lung cancer incidence across English Primary Care Trusts, 2004–2006. They would also like to thank members of the wider LUCADA steering group, Dr Paul Beckett, Prof Anne Tattersfield, and Mr Ken Purslow. The authors would also like to acknowledge the support offered by the Biomedical Research Unit, at
References (11)
- et al.
Recent cancer survival in Europe: a 2000–2002 period analysis of EUROCARE-4 data
Lancet Oncol
(2007) - SEER:...
- Cancer Research UK....
- Cancer Reform Strategy. Achieving local implementation-second annual report. Department of Health, London;...
- National Lung Cancer Audit 2009. Report for the audit period 2008. The NHS Information Centre for Health and Social...
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This work is attributed to Division of Epidemiology and Public Health, University of Nottingham.