Article Text


Pleural disease
P203 Addressing low surgical resection rates for Non Small Cell Lung Cancer: local intervention to address high levels of emergency presentations at late stage should be effective.
  1. EM Hadley
  1. Barking, Havering & Redbridge NHS Trust, London, UK


Introduction The National Lung Cancer Audit is a benchmarking tool for cancer networks and individual MDT’s. The national average resection rate for all lung cancer patients is 13.7%. The NLCA recommend that all MDTs with a resection rate for NSCLC below 14%, and for stage 1a–2b below 52% should be reviewed to ensure that patients are being offered appropriate access to thoracic surgical expertise.

In the 2011 report our MDT had a resection rate for NSCLC of 7.8%. In light of this a review of all cancer patients was carried out.

Results and discussion The resection rate for stage 1a-2b NSCLC patients was 48% which is similar to the national average. However the number of patients presenting with operable stage 1a-2b disease was unusually low at 12%.

An in depth review of 18 patients with operable NSCLC showed that there were four patients that did not have a curative resection. Two were performance stage 3–4 at presentation, one had a tumour in an inoperable location and the fourth had significant co-morbidities precluding surgery.

The opportunity for patients to be offered surgical treatment of stage 1a-2b NSCLC at this MDT is within national targets. However the low figure on the LUCADA data is due to an unusually high proportion of patients (88%) presenting with stage 3–4 disease. This is refected locally where we also have very high rates of lung cancer presenting via emergency admissions, around 70%. The national average is around 30–40%, a figure which is already considered unacceptable.

Conclusion In order to improve the rate of curative resection and improves survival for our population the key intervention is to diagnose more NSCLC at an early stage. We need to target the local population to present early, and empower primary care to refer early. We will study the impact of the 2012 National Lung Cancer Awareness Programme with interest, although it is likely that a further local campaign targeted at our specific community may be needed if we are to turn around local resection rates.

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