Variation in access to treatments for lung cancer ( ODR1718_079 )

The purpose of this service evaluation is to establish:

 factors that affect access to lung cancer treatments for non-small cell lung cancer (NSCLC) patients

 whether there is variation between hospital trusts in access to a range of treatment pathways.

 the impact of patient, tumour and provider characteristics on access to treatments.

This project will build upon work already completed by NCRAS (which investigated the characteristics that affect access to treatment for stage 4 lung cancer patients), by examining access to treatments for all NSCLC patients.

In addition, Cancer Research UK will investigate potential variation in the application of combined chemoradiotherapy and sequential chemoradiotherapy.

 Combined chemoradiotherapy is linked with increased long-term survival and is recommended by NICE guidelines for stage 3 NSCLC patients, although in practice the interpretation of this recommendation for stage 3a and 3b patients could vary. It is also possible that patients at other stages will receive this treatment.

Cancer Research UK will further examine the access to precision medicines which require molecular diagnostic testing for their use (Tyrosine Kinase Inhibitors).

Through this service evaluation, we will identify NHS Trusts that have significantly lower access to treatment or targeted therapies.

 Trusts with very low access to treatment rates suffer from barriers to patients receiving treatment.

 These barriers may include highly risk-averse decision making, or practical considerations which prevent patients from receiving treatment such as long travel times to hospital or inadequate support for patients when they are receiving these treatments.

 In some instances, such as frailty, old age or the presence of co-morbidities, it may be appropriate that patients do not receive a particular treatment. Patients may choose to not receive treatment.

 However, variation as a result of other factors such as geography, sex, deprivation status or ethnicity may be more problematic to explain, and this could highlight that more needs to be done to remove barriers to accessing treatments.

Identifying Trusts has previously been undertaken for SACT 30-day mortality work, and identifying particular Trusts would allow Cancer Research UK Health Professional Engagement Facilitators to engage with staff to identify strategies to increase treatment rates, and lower variation

In line with the National data opt-out policy, opt-outs are not applied because the data is not Confidential Patient Information as defined in section 251(10) and (11) of the National Health Service Act 2006.

Where individuals have opted out of disease registration by the National Disease Registration Service (NDRS), their data has been permanently removed from the registry and therefore will not be disseminated under this Data Sharing Agreement (DSA). https://digital.nhs.uk/ndrs/patients/opting-out

Nothing has changed since the initial application in terms of processing activities. There are no flows/movement of data any longer, the data is being stored inside the secure environment for the analysts to work on. There is no linking involved and no matching to publicly available data. Given the nature of this data, even though no identifying information (personal data) is present, the amount of detail present may result in small counts - even when this is the case all outputs leaving the environment are passed through Statistical disclosure control (SDC) checks and the analysts are trained and tested in SDC before they are given access to the environment, so there is no attempt to identify individuals at any point. Data is only accessible by substantive employees of Cancer Research UK who, as mentioned above, are trained and have to pass a test before being granted access to data.

Resubmitting to a journal is still being worked on. It is hoped that a year should allow for enough time for any resubmissions (should they be needed). Previous targets have been met in that a paper has been produced and submitted to a journal. Any outputs published have been already SDC checked to ensure there are no small numbers present and results are aggregated/rounded/suppressed enough.

The purpose of this service evaluation is to establish factors that affect access to lung cancer treatments for non-small cell lung cancer (NSCLC) patients – with a focus on those diagnosed at stage IIIA and IIIB; whether there is variation between Cancer Alliances in access to a range of treatment pathways, and the impact of patient and tumour on access to treatments. Complete findings will be shared via peer review publication. This will include odd ratios to highlight factor influence and funnel plots to illustrate geographic variation. Maps and infographics will follow later to communicate key findings more accessibly potentially via blog, lay-friendly report, or other grey literature etc. This work highlights the need for high quality reporting, and the identification of patient and healthcare factors that are associated with poor access to treatment should feed into the development of strategies to reduce variation. A standard operating procedure (SOP) will also be produced, allowing the methods to be generalised for other cancer sites, as well as any repeat analyses when further data years become available. This will allow Cancer Research UK to provide a service evaluation of access to treatment in terms of change over time.

Completing this service evaluation may highlight trusts who may benefit from reviewing their treatment decisions, as well as provide insights for recommendations to ensure equitable access to treatments. This could lead to changes in clinical practice (with respect to patterns in prescription, surgery and radiotherapy), and achieve better patient outcomes.

The results of this service evaluation may help a variety of audiences (including health professionals and patients) to better understand variation in access to treatment for NSCLC. Understanding the sources for this variation is the necessary first step in taking steps to ameliorate unwarranted variation. The primary audience is those delivering NSCLC services, including clinicians, healthcare managers, policy makers and commissioners.

Researchers may also be interested in these results, as poor access to treatment could contribute to the lower UK survival for lung cancer in international comparisons.

Not stated in the register.