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Original article
Impact of organisation and specialist service delivery on lung cancer outcomes
  1. Jana Bhavani Adizie1,2,
  2. Aamir Khakwani3,
  3. Paul Beckett3,
  4. Richard Hubbard3,
  5. Neal Navani3,
  6. Susan V Harden3,
  7. Ian Woolhouse1,2,3
  1. 1 Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
  2. 2 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3 Care Quality Improvement Department, Royal College of Physicians, London, UK
  1. Correspondence to Dr Ian Woolhouse, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; Ian.Woolhouse{at}


Introduction Data from the National Lung Cancer Audit (NLCA) often show variation in outcomes between lung cancer units which are not entirely explained by case mix. We explore the association between the organisation of services and patient outcome.

Methods Details of service provision were collected via an electronic survey in June 2017. An overall organisational score derived from eleven key service factors from national lung cancer commissioning guidance was calculated for each organisation. The results for each hospital were linked to their patient outcome results from the 2015 NLCA cases. Multivariate logistic regression analysis was used to link the organisational score to patient outcomes.

Results Lung cancer unit organisational audit scores varied from 0 to 11. Thirty-eight (29%) units had a score of 0–4, 64 (50%) had a score of 5–7 and 27 (21%) had a score of 8–11. Multivariate regression analysis revealed that, compared with an organisational score of 0–4, patients seen at units with a score of 8–11 had higher 1-year survival (adjusted OR (95% CI)=2.30 (1.04 to 5.08), p<0.001), higher curative-intent treatment rate (adjusted OR (95% CI)=1.62 (1.26 to 2.09), p<0.001) and greater likelihood of receiving treatment within 62 days (adjusted OR (95% CI)=1.49 (1.20 to 1.86), p<0.001).

Conclusion National variation in the provision of services and workforce remain. We provide evidence that adherence to the national lung commissioning guidance has the potential to improve patient outcomes within the current service structure.

  • lung cancer
  • thoracic surgery

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  • Contributors JBA, AK and IW: designed the study and analysed the results. JBA and IW: prepared the manuscript. All authors contributed to the interpretation of the results and the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.