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Variation in Lung Cancer Pathways: Insights from North Trent Cancer Network Review

This review evaluates lung cancer management pathways across the North Trent Cancer Network. It highlights significant differences in patient wait times for investigations and treatments among various regions, including Doncaster, Rotherham, Chesterfield, and Sheffield. Key findings reveal discrepancies in first and second investigation wait times, with implications for multidisciplinary team (MDT) practices. The analysis also explores the potential for improved chemotherapy and radiotherapy practices, alongside the need for streamlined protocols and enhanced GP involvement in referrals to address identified gaps in care.

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Variation in Lung Cancer Pathways: Insights from North Trent Cancer Network Review

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  1. Lung Pathway Review2 February 2011 North Trent Cancer Network

  2. Numbers Submitted

  3. Source of Presentation

  4. Discussion • Doncaster 74% Consultant Upgrade – Rotherham and Chesterfield 0% • Chesterfield and Sheffield high 2ww • Rotherham highest A&E admissions • Barnsley ? Mixed GP & Routine (2WW) Real differences or data quality?

  5. Treatment

  6. Discussion • Is there are variation in chemo practice? • Could more radiotherapy be used? – is Rotherham included in palliative – high A&E rates linked? Real differences or data quality?

  7. Pathways

  8. Barnsley – all patients Where an MDT took place

  9. Discussion • Average wait for 1st investigation = 17 days (assumed GP is 2ww) • Average wait between 1st and 2nd investigation = 7 days • Investigation to treatment decision longest period • Only 8 discussed at MDT? • Treatment not specified in data

  10. Chesterfield – 2ww patients Where an MDT took place

  11. Discussion • Average wait for 1st investigation = 14 days • Average wait between 1st and 2nd investigation = 9 days • 50% had 1 MDT, 22% had 3 or more • 3 breaches had not finished investigations by day 62

  12. Doncaster – 2ww and consultant upgrade patients Where an MDT took place

  13. Discussion • Average wait for 1st investigation = 5 days • Average wait between 1st and 2nd investigation = 2 days • 50% had 1 MDT, 22% had 3 or more • 5 breaches most had not got dtt by day 62

  14. Rotherham – 2ww patients Where an MDT took place

  15. Discussion • Average wait for 1st investigation =8 days • Average 1st – 2nd = 1 day • CT and bronchoscopy on same day • 75% had 1 MDT, 16% had 3 or more (surgery & chemo) • No breaches

  16. Sheffield – 2ww patients Where an MDT took place

  17. Discussion • Average wait for 1st investigation = 5 days • Average wait between 1st and 2nd investigation = 13 days • 12% had 1 MDT, 41% had 3 or more much more MDT discussion? • 5 breaches ? Average wait for 1st investigation = 14 days • Average wait between 1st and 2nd investigation = 22 days

  18. Average Days from Referral To 1st Treatment & 1st Treatment to 2nd Treatment Consultant Upgrade A&E

  19. Discussion • Doncaster & Sheffield significantly slower to 2nd investigation for consultant upgrade & A&E • Barnsley significantly quicker for consultant upgrade and A&E • 2WW – Doncaster & Rotherham quicker for 2nd investigation – average 7 & 9 days respectively with others being nearer 3 weeks (Barnsley max 24 days)

  20. Average Days Referral to Treatment No treatment data from Barnsley

  21. Discussion • Rotherham waiting longer for chemotherapy (small numbers or no local chemo)? • Need to understand Inter Trust Transfer – data does not tell us this - ideal pathway should be by day 28

  22. Investigations • Sequence 2ww patients (not Barnsley)

  23. Barnsley

  24. Chesterfield 2ww

  25. Doncaster 2ww

  26. Rotherham 2ww

  27. Sheffield 2ww

  28. Discussion • Generally sequence being followed • Chesterfield had a few bronch prior to CT • Only Sheffield using EBUS

  29. Investigations • Non 2ww patients (not Barnsley)

  30. Chesterfield Non 2 Week Wait Patients

  31. Doncaster Non 2 Week Wait Patients

  32. Rotherham Non 2 Week Wait Patients

  33. Sheffield Non 2 Week Wait Patients

  34. Discussion • More out of sequence but not many • Lot more investigations for this group of patients

  35. Discussion • Can all get to 2nd investigation by 2 weeks and how? • GP involvement improve this ? CT requests?? • Variation by oncology practice? (addressed by other future NSSG audits) • Consultant upgrades – consistency and streamlining them – how? • Role of MDT – variations in practice across the Network. When in the pathway do they need to be discussed – could decisions be made outside of the MDT to fast track investigations? • Role of EBUS – how will this impact once rolled out over Network?

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