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M.D. Peake



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    MINI 32 - Topics in Localized Lung Cancer (ID 166)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      MINI32.11 - 10 Years of National Lung Cancer Audit in the UK (ID 428)

      18:30 - 20:00  |  Author(s): M.D. Peake

      • Abstract
      • Presentation
      • Slides

      Background:
      The UK National Lung Cancer Audit has been collecting, analysing and reporting data on the management of lung cancer patients for 10 years. This abstract summarises the progress made in this period.

      Methods:
      Hospitals working within the UK National Health Service are invited to submit data to a web portal on all incident cases of lung cancer (and mesothelioma). The dataset covers demographics, referral, investigation, diagnosis, treatment and outcome.

      Results:
      Clinical and organisational engagement in the audit increased rapidly over the first 5 years such that currently all hospitals submit data on 100% of the expected incident cases, with 93% of cases having stage and performance status recorded. Measures of good practice have shown incremental improvements (e.g. histological confimation rate 68% to 75%, proportion with subtyped NSCLC 64% to 87%, proportion of patients seen by a specilaist nurse 51% to 84%, proportion receiving anti-cancer treatment 45% to 60%. The surgical resection rate in histologically-confirmed NSCLC has risen from 14% to 23% in keeping with other data sources, reinforcing the suggestion that these improvements reflect real changes in practice rather than just better data. Survival has improved in patients with early stage disease and good PS as previously published utilising the audit data (Khakwani et al 2013). Moreover, overall survival in the whole cohort appears to be improving when clinical features (age, sex, stage PS) are taken into acocunt as shown in Table 1.

      *Adjusted for age, sex, stage and PS
      Year HR* CI
      2008 1.0 -
      2009 0.97 0.96-0.99
      2010 0.96 0.94-0.98
      2011 0.90 0.90-0.93
      2012 0.88 0.87-0.90
      2013 0.87 0.85-0.89
      Despite these overall improvements in process and outcome, there remains a variatin in ractice across organisations that perists after adjustment for case-mix (example Figure 1). Figure 1



      Conclusion:
      The NLCA has been instrumental in driving improvements in lung cancer care in the UK. Future comparative audit projects spanning national and international boundaries hold the promise of further insights into variations in care and improvement in outcomes for our patients.

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    P1.10 - Poster Session/ Advocacy (ID 228)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Advocacy
    • Presentations: 1
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      P1.10-006 - Defining a Standard Set of Patient-Centered Outcomes for Patients with Lung Cancer (ID 78)

      09:30 - 17:00  |  Author(s): M.D. Peake

      • Abstract
      • Slides

      Background:
      Value-based healthcare improves outcomes while controlling costs. Registries and clinical trials frequently capture survival outcomes for lung cancer, but a unifying set of outcomes that matter to patients is lacking. Our objective was to define a Standard Set of multi-dimensional patient-centered health outcomes for measuring, comparing, and improving lung cancer treatment quality. This Set applies to all patients with newly diagnosed lung cancer, including non-small cell and small-cell lung cancer, treated with either curative or palliative intent.

      Methods:
      The International Consortium for Health Outcomes Measurement (ICHOM) convened an international, multi-disciplinary working group of medical oncologists, surgeons, radiation oncologists, pulmonologists, palliative care specialists, registry experts, patient representatives, and specialist nurses to review existing data and practices. Using a modified Delphi method, the group developed a consensus Set of important outcomes and case-mix variables for risk adjustment to enable meaningful benchmarking.

      Results:
      The outcome variables included in the Standard Set are overall survival, disease-specific mortality, cause of death, and treatment-related mortality. We recommend that complications during or within six months of treatment be collected. Patient reported outcomes should be tracked regularly using the EORTC QLQ-C30 core quality of life questionnaire and lung-cancer specific module (EORTC QLQ-LC13). Baseline demographic, clinical, and tumor information is also included in the Standard Set to improve interpretability of comparisons.

      Conclusion:
      We defined a Standard Set of outcomes that we believe should be measured in all patients with lung cancer. The Set provides a universal rubric for outcome comparisons, with the ultimate goal of improving the value of care. The Lung Cancer Standard Set is made possible through the generous support of the Alliance of Dedicated Cancer Centers

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