The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia

Our plain-English summary of The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia, by L. Mileshkin, C. Dunn, H. Cross, et al (Internal Medicine Journal, 2019).

The study

• Authors: L. Mileshkin, C. Dunn, H. Cross, M. Duffy, M. Shaw, P. Antippa, P. Mitchell, T. Akhurst, M. Conron, M. Moore, J. Philip, J. Bartlett, J. Emery, B. Zambello
• Journal: Internal Medicine Journal
• Published: 2019;49(8):1001-1006
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers.

Aim: To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service.

Methods: We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data.

Results: Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services.

Conclusion: Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.

© 2018 Royal Australasian College of Physicians.

In plain English

This was a retrospective audit of all patients newly diagnosed with lung cancer or mesothelioma in 2013 at six hospitals in Melbourne, Australia. Adapting the UK National Lung Cancer Audit data set, the authors drew on the Victorian Cancer Registry, hospital admissions data, hospital databases and medical records. Of 1303 patients first identified, 845 were within scope: 62% were male, 81% had non-small cell lung cancer, 9% small cell lung cancer and 21 (2%) mesothelioma. The article did not study asbestos exposure. Compared with UK figures for 2013, more Victorian patients were recorded as having a tissue diagnosis and surgery, more non-small cell lung cancer patients had a staging PET scan (73% versus 35%), and more of 669 patients with available data had radiotherapy (55% versus 29%). Fewer were recorded as discussed at a multidisciplinary meeting, receiving chemotherapy, or seen by a lung cancer nurse specialist. Many data fields were incomplete. The authors concluded that care appeared comparable to the UK, but that access to specialist lung cancer nurses appeared limited. They said future data collection should be prospective and harmonised across sites.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective clinical audit using descriptive statistics, with comparison to published UK National Lung Cancer Audit (NLCA) 2013 figures
• Who was studied: 845 patients newly diagnosed with lung cancer or mesothelioma in 2013 at six hospitals in Melbourne (Austin Health, Melbourne Health, Peter MacCallum Cancer Centre, St Vincent's Hospital Melbourne, Western Health, Werribee Mercy). They were selected from 1303 initially identified records.
• Main results:
  • Of the 845 patients, 526 (62%) were male and 317 (38%) were female.
  • By cancer type: non-small cell lung cancer 685 (81%), small cell lung cancer 76 (9%), mesothelioma 21 (2%). Staging was not recorded for 327 patients (39%).
  • Treatment with curative intent was recorded for 389 of 845 patients (46%). After adjustment, there was no significant difference between sites in rates of curative-intent treatment.
  • Histological diagnosis: 810 of 845 Victorian patients (96%), compared with 75% in the NLCA 2013.
  • Staging PET scan among non-small cell lung cancer patients: 73% in Victoria (544/748) versus 35% in the NLCA.
  • Active treatment: 76% (643/845) versus 60% in the NLCA. Surgery: 29% (242/845) versus 15%. Radiotherapy: 55% (370 of 669 patients; 176 patients had no available data) versus 29%.
  • Chemotherapy: 51% (327/638; 207 patients not applicable) in Victoria versus 70% in the NLCA. Data were missing for 311 patients, and some chemotherapy may have been given at outside sites.
  • Discussed at a multidisciplinary meeting: 585 of 845 (69%) versus 96% in the NLCA. Stage documented: 518 of 845 (61%) versus 93%.
  • Specialist palliative care: 21% versus 30% in the NLCA. Nearly half of the in-scope patients had no documentation for this item.
  • Contact with a lung cancer nurse specialist was recorded as 0% at diagnosis (versus 65% in the NLCA) and 13% at any point in the illness (versus 84%). Data completeness for these fields was 51%.
• The authors' conclusion: The authors concluded that, within the limits of a retrospective study, the six hospitals performed at a standard comparable to the UK in 2013. They found that Victorian patients appeared to have limited access to lung cancer nurse specialists, and that a prospective, standardized registry across sites would allow ongoing benchmarking.
• Limitations the authors state:
  • The audit was retrospective, and manual review of varied medical record systems was difficult and could introduce error.
  • Only care delivered at the six participating hospitals was captured. Some patients would have received parts of their care elsewhere, such as private or regional hospitals.
  • Large amounts of missing data limited interpretation, especially for palliative care and lung cancer nurse involvement, which may have occurred without being documented.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Mesothelioma, Cancer Registry, Small Cell Lung Cancer.

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