Background National Lung Cancer Audit reports consistently demonstrate variation in diagnostic pathways, treatment rates and outcomes which are not wholly explained by case-mix. One possible explanation for this variation is different access to diagnostics and treatment specialists, however little is known about the provision of these services across England and Wales lung cancer services.
Methods An electronic survey was sent to all lung cancer lead clinicians in England and Wales in January 2014. The survey included seven questions for all MDTs on service provision, diagnostic services, staging services, and lung cancer treatment. There were a further 3 questions for treatment centres. Two reminders were sent and the survey closed in May 2014.
Results 128 records were submitted from 176 trusts. After removal of duplicate and empty records 101 were available for analysis. Mean (range) average number of patients discussed per MDT meeting is 26 (5–88) and 29% Trusts have a separate diagnostic meeting. There is considerable variation in the mean (range) number of whole time equivalent (wte) on site lung cancer specialists e.g. thoracic pathologists 1.4 (0–10), lung CNS 2.0 (0.5–10) and respiratory physicians 3.9 (0–20). Most diagnostic and staging procedures are available either on or off site, although medical thoracoscopy is not available at all to 14% Trusts. Chemotherapy, radiotherapy and surgery are available on site in 89%, 33% and 18% of Trusts, respectively. VAT lobectomy, stereotactic radiotherapy and radiofrequency ablation are not available at all to 6%, 5% and 10% of Trusts, respectively. Centres performing thoracic surgery report mean (range) wte number of surgeons at 1.5 (0–6) and thoracic HDU beds at 4 (0–24). Acute oncology services are available to 92% chemotherapy treatment centres and 96% radiotherapy centres.
Conclusion The data provide a moderately representative snapshot of diagnostic and treatment services available for lung cancer patients in England and Wales. There is significant variation in the number of specialists available and some patients do not have access to key treatment modalities e.g. VAT lobectomy. Further work is required to determine how this relates to patient experience and outcomes. All Trusts are encouraged to submit validated data for the next round of organisational audit.
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