Virtual Library

Start Your Search

Paul Beckett



Author of

  • +

    MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 13:30 - 15:00, Room 201 F
    • +

      MA18.11 - Implementing a Comprehensive National Audit of Lung Cancer Surgery: The English Lung Cancer Clinical Outcomes Publication (LCCOP) Project (ID 12090)

      14:35 - 14:40  |  Author(s): Paul Beckett

      • Abstract
      • Presentation
      • Slides

      Background

      We report the establishment of a national audit of outcomes after lung cancer resection (LCCOP) in the English National Health Service (NHS), a government healthcare system providing the great majority of lung cancer surgery. LCCOP is a compulsory audit commissioned by NHS England.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Unusually, for a surgical audit, data is initially obtained from the cancer registry, and matched to national Hospital Episode Data (HES), before local validation by clinical teams. After case mix adjustment, unit level survival rates at 30, 60 and 90 days, and length-of-stay data are published online and in an annual report. The first annual report was released in 2014.

      Survival is adjusted for age, sex, performance status, stage, laterality, FEV1 percentage, comorbidity and socioeconomic status

      4c3880bb027f159e801041b1021e88e8 Result

      The number of resections rose by 21% between 2015-2017 (4892 to 5936). Median annual activity per surgeon rose from 30 to 49 cases between 2014-2017, a 63% increase. In 2015 survival at 30, 90 and 365 days was 98.1%, 96.3% and 87.9% respectively. Median length of stay was 6 days (IQR 4-9).

      In 2015, 43.9% of lobectomies were completed by VATS, 4.3% were started VATS and completed by open surgery and 0.7% completed by robotics.

      Adjusted 90 day survival by surgical unit: 2017 report (2015 data)

      90 day 2017(15).png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Using routinely collected NHS activity data for surgical audit is feasible, and reduces the data collection burden for hospital teams. Clinical validation remains important to correct discrepancies. Surgical activity has risen significantly. Increases in individual surgeon case volume may reflect increasing subspecialisation. Significant inter-provider variation remains, particularly in length of stay.

      More lung cancer surgery is being done in the English NHS. Surgeons are increasingly subspecialising, with higher case volumes. Local variation remains, particularly around length of stay. A mixed model of routinely collected data with local validation appears acceptable to clinical units.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P1.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 949)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.17-04 - Curative Intent Treatment for Stage III NSCLC in England (ID 14010)

      16:45 - 18:00  |  Author(s): Paul Beckett

      • Abstract
      • Slides

      Background

      The National Lung Cancer Audit (NLCA) produces annual reports detailing standards of care for lung cancer. This further analysis investigates the use of curative intent multi-modality treatment for people in England diagnosed with stage III NSCLC during 2016, including, for the first time, details about use of concurrent and sequential chemoradiation (cRT).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Data on patients diagnosed during 2016 with stage III NSCLC in England were extracted from the National Cancer Registration and Analysis Service (NCRAS); information submitted through the Cancer Outcome and Services Dataset (COSD) were linked to other NCRAS datasets, including Hospital Episode Statistics (HES), the National Radiotherapy Dataset (RTDS) and the Systemic Anti-Cancer Dataset (SACT).

      4c3880bb027f159e801041b1021e88e8 Result

      6,288 cases of stage III NSCLC were analysed, 3839 Stage IIIA and 2449 Stage IIIB (Table 1).

      813 (13%) people underwent surgery with 447 (7%) of these also receiving chemotherapy (predominantly adjuvant).

      1047 (17%) people were treated with radical radiotherapy with 676 (11%) of these also receiving chemotherapy.

      For the 589/676 cRT cases where complete treatment dates were available, 199 (34%) received concurrent and 390 (66%) received sequential chemoRT (37% and 63% for stage IIIA).

      For 481/589 cases with performance status (PS) available, 171 (36%) PS0-1 cases received concurrent and 310 (64%) received sequential cRT (38% and 62% for stage IIIA)

      Of note, 2148 (34%) people received anti-cancer treatment of palliative intent and 2290 (36%) received supportive care only.

      Survival data will also be presented.

      Table 1
      wclc 2018 abstract 14010 table.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Multi-modality treatment with either surgery or radical radiotherapy combined with chemotherapy was delivered to 1123 (18%) patients with stage III NSCLC. Concurrent cRT, optimal cRT based on meta-analysis, was delivered to just over one third of people receiving cRT, including for patients of good PS0-1. This analysis provides a baseline for future quality improvement initiatives to optimise treatment and outcomes for patients with stage III NSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.06-12 - Improving Quality of Care for Pleural Mesothelioma: 2018 National Mesothelioma Audit Results for England and Wales  (ID 12816)

      16:45 - 18:00  |  Author(s): Paul Beckett

      • Abstract
      • Slides

      Background

      The National Lung Cancer Audit (NLCA) has previously produced reports detailing standards of care for mesothelioma in 2013 (covering diagnoses in 2008-2012) and in 2015 (covering 2014), funded by Mesothelioma UK. We have completed a further analysis using the most recent data available.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Data on patients in England and Wales with a diagnosis of mesothelioma in the years 2014-2016 were extracted from the National Cancer Registration and Analysis Service (England), and the Cancer Network Information System Cymru (Wales). The data were linked to other datasets, including Hospital Episode Statistics (HES), the National Radiotherapy Dataset (RTDS), the Systemic Anti-Cancer Dataset (SACT), pathology reports and death certificate data.

      4c3880bb027f159e801041b1021e88e8 Result

      6,932 cases of malignant pleural mesothelioma were analysed. 84% of cases were male. Performance Status (PS) was recorded in 69% (falling) and tumour stage in 54% (rising).

      88% of patients had a pathological confirmation of the diagnosis, and in 64% there was a pathological subtype recorded. 51% of patients received active anti-cancer treatment, and 59% of PS 0-1 patients received chemotherapy (up from 41% and 54% in previous reports). 4% of patients received radical debulking surgery. One-year survival of 38% was lower than previous reports but should be interpreted with caution. Three-year survival was only 7%.

      Variation in the quality of the pathological diagnosis and in rates of treatment and survival are seen across regions (Table 1).

      Cancer Network

      No. of Cases

      Pathological Subtyping1

      Anti-cancer treatment2

      Chemotherapy3

      Surgery4

      Radiotherapy5

      One-year survival6

      London Cancer Alliance (N44)

      436

      70.3

      56.0

      78.3

      5.0

      20.9

      41.4

      Cheshire and Merseyside (N50)

      259

      69.2

      45.9

      50.8

      1.9

      26.6

      38.2

      Greater Manchester, Lancs and S. Cumbria (N51)

      616

      37.1

      55.2

      70.7

      1.3

      20.6

      36.9

      Northern England (N52)

      528

      74.9

      50.4

      69.4

      0.8

      20.3

      37.3

      Yorkshire and The Humber (N53)

      772

      49.6

      46.4

      54.7

      3.0

      18.3

      37.6

      East of England (N54)

      827

      73.3

      49.7

      56.3

      7.5

      18.0

      40.2

      East Midlands (N55)

      466

      71.9

      51.7

      53.3

      14.4

      13.7

      38.4

      West Midlands (N56)

      466

      52.8

      51.1

      52.3

      6.0

      28.5

      30.8

      South West (N57)

      586

      73.8

      48.0

      51.1

      1.4

      26.1

      39.8

      South East Coast (N58)

      661

      61.6

      54.3

      62.7

      5.4

      22.7

      35.7

      Thames Valley (N59)

      238

      52.7

      56.7

      58.6

      7.1

      30.7

      41.9

      Wessex (N60)

      462

      73.5

      50.2

      48.6

      1.7

      28.8

      37.8

      London Cancer (N61)

      325

      66.8

      58.2

      59.3

      3.1

      24.6

      40.3

      North Wales (NWW)

      78

      60.0

      42.3

      54.1

      3.8

      16.7

      39.0

      South Wales (SWCN)

      212

      77.7

      53.8

      60.5

      0.0

      23.6

      39.4

      1 Proportion of patients where mesothelioma histological subtype is recorded

      2 Proportion of patients receiving one of surgery, radiotherapy or chemotherapy

      3 Proportion of patient with PS 0-1 who received chemotherapy as treatment of their mesothelioma

      4 Proportion of patients undergoing radical surgery as treatment of their mesothelioma

      5 Proportion of patients receiving radiotherapy as treatment of their mesothelioma

      6 Proportion of patients with mesothelioma who survive at least 1 year following diagnosis

      Table 1: Main performance measures by Cancer Network (pleural mesothelioma)

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite a rise in the number of eligible patients receiving chemotherapy, there remains poor long-term survival for patients with mesothelioma. As well as introduction of novel therapies, improvements in care and outcome could be achieved by reducing variation.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.16-21 - Post-Treatment Survival Difference Between Lobectomy and Stereotactic Ablative Radiotherapy in Stage 1 Non-Small Cell Lung Cancer in England (ID 12349)

      16:45 - 18:00  |  Author(s): Paul Beckett

      • Abstract
      • Slides

      Background

      Non-small cell lung cancer (NSCLC) accounts for almost 85% of all lung cancer cases diagnosed in England. Stage 1 lung cancer represents around 15-20% of all NSCLC cases, and while surgical resection (the current standard of care) offers the best chance to improve survival and is the standard of care in early lung cancer, not all patients undergo surgical treatment due to their advanced age and/or multiple comorbidities, while others may refuse surgery. Stereotactic ablative radiotherapy (SABR), a non-invasive external beam radiotherapy, has become an established treatment option for such patients. The aim was to compare survival at 90 days, 6 months, one year and overall for patients who received either lobectomy or SABR for NSCLC stage IA and IB.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We used data from the 2015 National Lung Cancer Audit (NLCA) database that were collected by Public Health England (PHE) and linked with Hospital Episode Statistics (HES) and the Radiotherapy Dataset (RTDS) to identify patients with NSCLC stage IA-IB and performance status 0-2 who underwent surgery or SABR treatment. We looked at survival risk difference at 90 days, 6 months, 1 year and 1 year between the two patient groups using propensity score derived using a logistic regression model with covariates that were predictive of treatment including age, sex, performance status and stage.

      4c3880bb027f159e801041b1021e88e8 Result

      We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening performance status were associated with having SABR rather than surgery. Patients who had SABR had 1.4% better survival at 90-days; however, this survival benefit dropped at 6 months after treatment started and patients who had surgery had 14% better overall survival.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our analysis suggests that, while patients who underwent SABR have better short-term survival, patients who have surgery have better overall survival. However, the time to the start of treatment with SABR was 8 weeks longer than for surgery. Thus early survival may be underestimated for SABR although other (conflicting) factors may be at play including stage-shift (more in SABR group) and length time (potentially more indolent tumours in the SABR group).

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.