Annual Report (2016 cohort)

 North Cumbria University Hospitals NHS Trust (RNL)

 Northern England Strategic Clinical Network
 Clinical Lead: Matthew Lane

This performance report details results specifically for the period January 2016 - December 2016 inclusive, and compares this to the national average for the same period, as well as the performance of the trust in previous years. Data for 2013 was collected through the LUCADA system and data for 2014 was collected through a hybrid mechanism (LUCADA for some trusts, COSD for others) so may not be directly comparable. Data for 2015 did not undergo detailed validation. All these historic comparisons are given for infomation only. The number of cases submitted refers to cases allocated as the "trust first seen", based on an NLCA/NCRAS algorithm.

 Summary of Unadjusted Results

Trust Cases PCR 1 LCNS 2 Anti-Cancer 3 Curative 4 Surgery 5 NSCLC SACT 6 SCLC Chemo 7 Survival 8
Northern England 2965 70.4% 82.7% 60.3% 85.7% 15.2% 65.6% 72.5% 34.5%
South Tyneside NHS FT 158 64.6% 94.9% 60.8% 83.8% 16.3% 50.0% 80.0% 42.3%
City Hospitals Sunderland NHS FT 330 66.1% 82.7% 57.9% 78.9% 11.9% 51.6% 85.7% 36.4%
North Cumbria University Hospitals NHS Trust 250 66.8% 86.8% 52.0% 85.7% 13.2% 52.9% 66.7% 28.4%
Gateshead Health NHS FT 230 64.8% 86.5% 55.2% 84.6% 12.8% 73.7% 83.3% 31.7%
The Newcastle Upon Tyne Hospitals NHS FT 373 72.7% 88.7% 65.4% 90.2% 17.7% 83.9% 76.0% 38.3%
Northumbria Healthcare NHS FT 410 66.3% 80.7% 56.3% 78.6% 13.5% 59.6% 65.9% 32.6%
South Tees Hospitals NHS FT 400 80.5% 82.5% 66.0% 91.0% 17.9% 75.6% 62.7% 35.8%
North Tees and Hartlepool NHS FT 325 76.3% 87.7% 66.5% 87.1% 18.5% 65.2% 73.9% 32.7%
County Durham and Darlington NHS FT 489 68.9% 68.5% 58.9% 86.4% 14.4% 70.5% 71.6% 33.9%
England 36,758 72.1% 70.3% 58.2% 80.4% 17.5% 62.5% 68.0% 37.0%

1 Proportion of all patients with pathological confirmation of cancer :: 2 Proportion of all patients assessed by a specialist nurse :: 3 Proportion of all patients who have anti-cancer treatment (surgery, radiotherapy systemic treatment) :: 4 Proportion of patients with stage I/II and PS 0-2 receiving treatment with curative intent (surgery or radical radiotherapy) - this measure is only available for England :: 5 Proportion of patients with NSCLC who undergo surgery :: 6 Proportion of patients with Stage 3B/4 and PS 0-1 who have systemic anti-cancer treatment :: 7 Proportion of patients with SCLC who undergo chemotherapy :: 8 Proportion of patients alive at 1 year after diagnosis

 Disease Stage

Trust Stage Recorded Stage I/II
Northern England 96.5% 25.0%
South Tyneside NHS FT 97.5% 31.8%
City Hospitals Sunderland NHS FT 93.0% 21.8%
North Cumbria University Hospitals NHS Trust 97.2% 22.2%
Gateshead Health NHS FT 97.8% 22.7%
The Newcastle Upon Tyne Hospitals NHS FT 96.8% 24.1%
Northumbria Healthcare NHS FT 96.3% 23.0%
South Tees Hospitals NHS FT 97.8% 28.9%
North Tees and Hartlepool NHS FT 97.2% 26.0%
County Durham and Darlington NHS FT 96.1% 26.0%
England 95.5% 27.3%

 Performance Status

Trust PS Recorded PS 0-1
Northern England 89.1% 52.5%
South Tyneside NHS FT 98.7% 54.5%
City Hospitals Sunderland NHS FT 75.8% 53.6%
North Cumbria University Hospitals NHS Trust 86.8% 50.7%
Gateshead Health NHS FT 91.7% 39.3%
The Newcastle Upon Tyne Hospitals NHS FT 89.8% 47.5%
Northumbria Healthcare NHS FT 91.5% 57.1%
South Tees Hospitals NHS FT 93.0% 51.3%
North Tees and Hartlepool NHS FT 94.2% 57.2%
County Durham and Darlington NHS FT 85.7% 56.1%
England 81.6% 53.8%

Sections below show key performance indicators, with brief explanation of relevance. Case-mix adjusted results for 2016 cohort (adjusted for age, sex, stage, performance status and socio-economic status) and historical trends are shown. Significance describes performance outside 2SD (alert) or 3SD (alarm) - further details are available in our outlier policy.

A spreadsheet containing a detailed breakdown of these, and many other results is available here...

Pathological Confirmation

Pathological confirmation is the preferred means of diagnosis, as it is more accurate and helps to determine the most appropriate form of treatment. It is recognised that, in some very old or frail patients, attempts to perform invasive biopsies are not appropriate, and thus pathological confirmation may not be possible.


Adjusted Proportion
67.7%
Not significant
Unadjusted results over time
Anti-Cancer Treatment

Anticancer treatment refers to therapies (surgery, radiotherapy, chemotherapy) that have activity against the cancer itself, rather than just against the symptoms. Patients with lung cancer are often older and have other comorbidities, which can sometimes make treatments challenging, but delivering more anticancer treatment to patients is necessary to achieve the goal of improving quality of life and survival.


Adjusted Proportion
55.6%
Not significant
Unadjusted results over time
Surgery in NSCLC

Surgery remains the preferred treatment for early-stage lung cancer, and historically patients in the UK have been less likely to undergo surgery than patients in other countries, although the numbers have increased slowly over the past 10 years. Disease stage, PS and lung function measurements are crucial in determining whether to offer a patient a surgical operation. Survival after surgery is high (98% at 30 days), suggesting that there is scope to further increase the resection rate.


Adjusted Proportion
17.5%
Not significant
Funnel Plot of Adjusted Results
Unadjusted results over time
SACT in NSCLC Stage 3B/4 PS 0-1

Clinical trials have demonstrated that patients with advanced and incurable NSCLC can benefit from palliative chemotherapy, delivered to improve quality of life and to extend survival. Since this measure was first introduced, there have been significant developments in the treatment options available to patients, such that the term ‘chemotherapy’ should now be replaced by the term ‘systemic anticancer treatment’.


Adjusted Proportion
52.7%
Not significant
Funnel Plot of Adjusted Results
Unadjusted results over time
Chemotherapy in SCLC

SCLC is a particularly aggressive cancer, which is nearly always advanced at the time of diagnosis, so the role of surgery is controversial and not often appropriate. These tumours are, however, very sensitive to chemotherapy (and radiotherapy), and this can improve survival and quality of life. Patients may deteriorate quickly in the time between presentation and treatment, and so it is particularly important that the pathway is expeditious.


Adjusted Proportion
65.5%
Not significant
Funnel Plot of Adjusted Results
Unadjusted results over time
One Year Survival

The aim of treatment for lung cancer patients is to provide a cure for as many as possible, as well as to maintain quality of life in survivors and those who will still die of the disease. We do not set a target for survival; rather, we expect that attention to individual components will deliver improvements.


Adjusted Proportion
33.9%
Not significant
Funnel Plot of Adjusted Results
Unadjusted results over time