Analysis

How the UK's lung cancer services measure up

More lung cancer nurses are needed to boost survival rates of the UK’s biggest cancer killer. Nick Evans reports on workforce development in the four UK countries

More lung cancer nurses are needed to boost survival rates of the UKs biggest cancer killer. Nick Evans reports on workforce development in the four UK countries.

Improving access to specialist lung cancer nurses is one of the key steps needed to push up survival rates and stop the condition being a death sentence, experts say.

The UK Lung Cancer Coalition (UKLCC) says more specialist nursing along with other measures could help increase 5-year survival rates to 25% by 2025.

The UKLCCs report, 25 by 25: a ten-year strategy to improve lung cancer survival rates, highlights how poorly the health service is performing with figures showing wide variations in access to treatment, specialist nurses and low levels of early diagnosis.

16%

predicted 5-year survival rate for lung cancer patients diagnosed in 2013

The latest survival data,

...

More lung cancer nurses are needed to boost survival rates of the UK’s biggest cancer killer. Nick Evans reports on workforce development in the four UK countries.

lung cancer report
Picture: iStock

Improving access to specialist lung cancer nurses is one of the key steps needed to push up survival rates and stop the condition being a ‘death sentence’, experts say.

The UK Lung Cancer Coalition (UKLCC) says more specialist nursing along with other measures could help increase 5-year survival rates to 25% by 2025.

The UKLCC’s report, 25 by 25: a ten-year strategy to improve lung cancer survival rates, highlights how poorly the health service is performing with figures showing wide variations in access to treatment, specialist nurses and low levels of early diagnosis.

16%

predicted 5-year survival rate for lung cancer patients diagnosed in 2013

The latest survival data, for England only, put 5-year survival at 16% in 2013 – double what it was in 2005 but the second lowest of the 20 most common cancers.

The biggest killer

It means lung cancer remains the UK’s biggest cancer killer, responsible for more than 35,000 deaths each year. That equates to 22% of all cancer deaths and is more than breast, bowel, bladder and uterine cancer combined.

The UKLCC said specialist nurses should be part of all multidisciplinary teams as the evidence shows that patients who had access to them had a better experience of care, improved outcomes and increased access to treatment.

The coalition, which analysed existing data and carried out interviews with health staff and patients during its review, also calls for:

  • The introduction of a UK-wide screening programme for all at-risk groups informed by the results of the Nelson lung cancer study due next year.
  • An audit of waiting times following the regular breaching of the 62-day target for treatment in all four UK countries.
  • UK governments to commit to annual public awareness campaigns to improve knowledge about symptoms.
  • Standardised pathways to be developed setting out consistent post-referral processes including access to respiratory physicians, surgeons and specialist nurses.

UKLCC clinical advisory group member Lavinia Magee, who works as a lung cancer nurse consultant, says: ‘We cannot be complacent. Lung cancer survival rates across the UK still lag severely behind our European counterparts and compare poorly with other major common cancers types.’

She describes access to lung cancer nurse specialists ‘as one of the most important contributing factors to improving long-term patient survival’.

She stresses that ‘due to financial pressures there aren’t enough nurses compared to the number of patients diagnosed’.

So how is each part of the UK doing?

England

NHS bosses set out a five-year cancer strategy in the summer of 2015, which noted the low survival rate for lung cancer. A chest symptoms awareness campaign has subsequently run this year.

But problems remain, according to the UKLCC. Access to a lung cancer specialist nurse varies from 34% of patients in one area to 100% in another.

Although there are signs the workforce has been invested in. There was a 10% rise in hospital-based specialist nurses for all types of cancer between 2011 and 2014, according to an audit by Macmillan Cancer Support.

But the increase in those working in lung cancer was about half that – meaning the number of specialist nurses per patient was the second worst of the common cancers at one per 125 cases a year.

The report also highlighted that stop smoking services were under threat in four in 10 local authorities and the proportion of patients receiving anti-cancer treatment varied from 32% to 83% across hospital trusts.

Scotland

Scotland has recently published its own cancer plan also, but the UKLCC is disappointed that it had no specific actions for lung cancer despite the disease causing 25% of all cancer deaths.

On the plus side the numbers being seen by a lung cancer clinical nurse specialist (CNS) rose from 81% to 84% between 2013 and 2014.

A greater proportion of CNS posts in Scotland – 17% - specialise in lung cancer than the other UK nations, according to the Macmillan audit. Although the number of specialist nursing posts per cancer is still lower than it is in England and Wales at 1 per 140.

The report noted progress is being made in the number of patients being offered surgery.

Wales

Lung cancer has been identified as one of five cancer priorities by ministers, with a focus on early diagnosis. To help, an awareness campaign covering lung cancer has been running this year.

The nation also has the highest rates of multidisciplinary team involvement – 99.6% – out of all the parts of the UK. But only 88% of patients had access to a CNS, according to latest figures.

In terms of numbers, however, it had one nurse per 113 cases in 2014, the best rate in the UK.

Wales also sees a large number of patients being diagnosed late – only 12% are diagnosed at stage one. Wales was ranked 28th out of 29 European countries by the latest Eurocare study.

Northern Ireland

The nation had the lowest number of specialist lung cancer nurses to patients out of the whole of the UK in 2014. There were 159 cases per nurse, according to Macmillan with just 7.5 full-time dedicated lung cancer posts across the five health and care trusts.

It is perhaps not surprising since the overall rise in specialist nurses between 2011 and 2014 was just 2%, compared with 10% in England.

Multidisciplinary team involvement is also low compared with other parts of the UK. But in the past few years there has been investment in specialist nursing posts with the UK Oncology Nursing Society (UKONS) expecting to see a doubling of the 2014 total within the next few years – albeit with the new posts being created at a lower band – band 6 – than the existing CNS roles.

How feasible is progress?

Given the problems identified and the pressures on the system, it may not seem the best time for ambitious plans. But there is optimism that lung cancer care can be improved.

25%

UKLCC goal for 5-year survival for lung cancer by 2025

Wales Cancer Network Macmillan lead nurse Gillian Knight says the solution lies in creating new roles to support registered specialist cancer nurses.

She highlights pilot schemes taking part in Wales as well as elsewhere in the UK, with posts created to take on jobs such as benefits advice, preparing results for clinics and making referrals, freeing specialist nurses to spend more time on patient care.

‘Because of the nature of lung cancer, specialist cancer nurses tend to be involved in the whole pathway from investigations and treatment to the end of life.

‘But about 30% of what registered specialist cancer nurses do could be supported by another appropriately trained member of the team.’

She says if such posts are properly funded it is ‘feasible’ to ensure all patients have access to a CNS.

22%

proportion of UK cancer deaths lung cancer represents

UKONS president elect Richard Henry agrees support roles will make an important difference.

He also says there needs to be progress on screening too. ‘Lung cancer symptoms tend to show up at quite a late stage so we need to identify people before they are symptomatic.

‘There have been trials, which by all accounts have worked well. With screening we should see a significant improvement in survival rates.’

National Lung Cancer Forum for Nurses chair Diana Borthwick believes tackling the wide variations in care is important too. She says the report ‘lays down the challenge’ for the lung cancer community and government.

‘We have an opportunity to address the problems and make sure lung cancer does not remain the poor relation when it comes to cancer.’

Number of new cases per year for each specialist lung cancer nurse (WTE)
  • England 125
  • Wales 113 
  • Scotland 140 
  • Northern Ireland 159 

Source: Macmillan Cancer Support 2014

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