Lung Cancer Network Group. Lung Cancer Awareness Month November 2010

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1 Lung Cancer Network Group Lung Cancer Awareness Month November 2010 Lung cancer is the leading cause of cancer related death in the Northern Ireland and the UK 1,2. Each year in Northern Ireland approximately 900 patients are diagnosed with lung cancer. Unfortunately the majority of patients have advanced disease at the time of diagnosis. In an attempt to reduce the rates of lung cancer and to improve treatments for those patients with lung cancer, there have been several developments over the past year in the NI Lung Cancer Community which have demonstrated a commitment to maintaining and improving the quality of care, and increasing the involvement of patients both in decisions about their own care and the design and delivery of lung cancer services. Contents Prevention of Lung Cancer and Smoking Cessation... 2 Peer Review and Regional Audit... 2 Table 1: Summary of findings from the UK National LUCADA report... 2 Figure 1: Radical Resection Rate for Pathological Proven NSCLC... 3 Figure 2: Active Treatment Rates... 3 Reduced time to diagnosis... 3 Radiotherapy Treatments... 4 Chemotherapy Treatments... 5 Patient Involvement... 6 NICaN web pages for lung cancer... 6 Abbreviations... 6 References... 6

2 Prevention of Lung Cancer and Smoking Cessation It has been known for some time that smoking is strongly related to lung cancer. It has also been shown that continuing smoking after a diagnosis of lung cancer reduces the chance of response to treatment. In an effort to reduce smoking rates and thus the number of new diagnoses of lung cancer, patients seen for any reason in any NHS clinic are encouraged to give up smoking. This is supported by a Smoking Cessation Helpline and several Smoking Cessation Clinics across Northern Ireland. Peer Review and Regional Audit The Northern Ireland Cancer Network (NICaN) has recently undertaken a peer review of all the Lung Cancer Multidisciplinary Meetings (MDMs) across the province. The feedback has largely been positive. A regional audit of patients diagnosed in 2006 has allowed comparison to our UK colleagues via the UK National LUCADA report. The proportion of patients receiving treatment for their cancer (Active anti-cancer treatment) in Northern Ireland compares well with rates at leading UK centres such as the Royal Marsden and Christie. Furthermore, the surgical resection rates in NI are amongst the highest in the UK (See Table 1 and Figure 1 and 2). Table 1: Summary of findings from the UK National LUCADA report. Descriptor LUCADA LUCADA RMH Christie Lothian NI Total number of patients % of Patients undergoing Surgical Resection 11% >=10% 9% 8% 8.2% 18% % Patients receiving any active anticancer treatment (Chemotherapy, >=51% 38% 38% 62% 64% Surgery or Radiotherapy) % of Patients receiving Chemotherapy for SCLC 58% >=62% 54% 62% 76%

3 Figure 1: Radical Resection Rate for Pathological Proven NSCLC Radical resection rate for pathological proven NSCLC 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% RMH Christie Lothian NI 2006 Figure 2: Active Treatment Rates Active Treatment Rates 70% 60% 50% 40% 30% 20% 10% 0% RMH Christie Lothian NI 2006 Reduced time to diagnosis To reduce the time needed to make a diagnosis of lung cancer, a central rapid access clinic has been set up at the Belfast City Hospital for patients in the Belfast Trust area to allow prompt assessment and diagnosis for patients who have suspected lung cancer. Patients with mild-moderate COPD from 15 GP practices are also participating in a national lung cancer screening trial, combining a special sputum test, low-dose CT scanning and autofluorescence bronchoscopy to detect lung cancer at its earliest stage when it is curable. The lung-search study is the first lung cancer screening trial in Northern Ireland.

4 Radiotherapy Treatments Radiotherapy is given to 66% of patients referred to the oncology service. Most lung cancer radiotherapy treatments are given to patients with advanced disease and in this setting radiotherapy can significantly improvement the symptoms of lung cancer and improve a patient s quality of life. Radiotherapy can also be used to cure lung and over the last number of years the Northern Ireland Cancer Centre has conducted a research study examining the use of PET-CT scanning in the design of individual lung cancer radiotherapy treatments. The findings from this study have been presented at several international meetings and publishing in leading radiotherapy journals 3. It is hoped that this method of radiotherapy planning may introduced into routine clinical practice for appropriate patients over the next year. Continuous audit of radiotherapy treatments has shown a reduction in the time taken to start patients on radical radiotherapy over the past 3 years. This is largely due to the facilitation through the planning process by a dedicated specialist lung radiographer. There has been an improvement in radical radiotherapy techniques in two key areas: 1. An increase in the use of concurrent chemotherapy and radiotherapy (The delivery or chemotherapy and radiotherapy at the same time which can improve cures rates by 5% to 10%); 2. The development of a technique to compensate for the respiratory movement of lung tumours during the delivery of each fraction of radiotherapy (improving the accuracy and reducing the toxicity of treatment). Stereotactic radiotherapy for early stage NSCLC (non small cell lung cancer) has shown improved cure rates compared to conventional radiotherapy. Whilst the technology needed to deliver this form of radiotherapy is not yet available in Belfast, approval has been given for patients to have access to this treatment in Leeds.

5 Chemotherapy Treatments There has been a marked increase in the volume of lung cancer chemotherapy delivered throughout the province from 12% in 2001 to 28% in This reflects the increasing access to systemic treatments. There was an increase in 1 year overall survival documented during this same time period from 23% to 27%. Several chemotherapy trials have been run through Belfast and actively recruited to. The hope is to move clinical studies out to the cancer units across NI to improve access for patients. It is hoped that the first of these NI wide trials will be the FRAGMATIC trial. There have been several key developments in types of chemotherapy available to lung cancer Patients over the past two years. Erlotinib, an oral tyrosine kinase inhibitor, has been successfully introduced as the standard 2 nd line chemotherapy treatment for NSCLC. Recent NICE guidance has supported the use of tailored, targeted treatment for NSCLC. Pemetrexed based chemotherapy has been shown to improve survival for non-squamous NSCLC and has been delivered to at least 10 patients by single patient access (a business case is being considered by commissioners). Gefitinib, another oral TKI, has been demonstrated to show marked improvements in disease response and disease control in patients with an activating mutation in genes producing an EGFR protein. Six patients have been treated with drug provided by single patient access (a business case is being considered by commissioners). This drug has opened the era of molecularly targeted therapy and the individualisation of lung cancer treatments. At present the Pathology community is working on the development of a NI molecular diagnosis service.

6 Patient Involvement Lung cancer support groups have been set up and have been well supported by patients affected by lung cancer. These have been very positively received. Lung Cancer Nurse Specialists (LCNS) had provided support to patients in addition to the medical assessment traditionally received at clinics. In addition to the clinical support given by the team of LCNS, the team of nurses provide an increased opportunity for patients and their families to learn about and avail of other complementary and support services. Invaluable support is also delivered by the social work and palliative care nursing teams, including the development of specialist clinics to help with breathlessness. NICaN web pages for lung cancer Web information for people affected by lung cancer: NICaN Lung Cancer Network Group: NICaN Lung Cancer Information Pathway: Abbreviations EGFR LCNS NI NICE NSCLC SCLC UK Epidermal Growth Factor Receptor Lung Cancer Nurse Specialist(s) Northern Ireland National Institute for Health and Clinical Excellence Non-small Cell Lung Cancer Small Cell Lung Cancer United Kingdom References 1.) Toms, J. R., (ed), CancerStats Monograph 2004 London: Cancer Research UK. 2.) Bannon, F., & Gavin, A., Monitoring care of Lung cancer patients in Northern Ireland diagnosed 2006 (with comparisons 1996 & 2001). Available at: [Accessed 13 th February 2010]. 3.) Hanna GG, McAleese J, Carson KJ, Stewart DP, Cosgrove VP, Eakin RL, Zatari A, Lynch T, Jarritt PH, Young VAL, O Sullivan JM, Hounsell AR. 18F-FDG PET-CT simulation for nonsmall cell lung cancer: What is the impact in patients already staged by PET-CT? Int J Radiat Oncol Biol Phys 2010;77(1): doi: /j.ijrobp

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