National Lung Cancer Audit Frequently Asked Questions What dataset should be used? Please see the LUCADA data manual v3.1.3, available in the downloads section What does LUCADA stand for? LUCADA stands for Lung Cancer Data Who has agreed the outputs and supporting dataset? The NLCA Clinical Reference Group (CRG) identified the priority outputs of the audit. What software is to be used for collecting the LUCADA dataset? The programme has commissioned the development of a web-based (NHSnet) audit IT infrastructure system from the National Health Applications & Infrastructure Services (NHS CFH). What are the security arrangements for LUCADA? Each organisation must first complete a data user certificate, this identifies all users of the system and requires the signature of the Trust Caldicott Guardian. Access to the system is controlled by centrally assigned user names and passwords. The core system uses the same access and security controls as the Open Exeter and CWT systems; named access is over a secure network through the Open Exeter portal Is it possible to upload data to the central database, rather than via the data entry screens? Yes, both CSV and XML file specifications are being developed for upload to the central database.
When can an organisation start to use the audit application? As soon as the registration has been processed and a password issued. How long is a password valid for? Passwords expire every 28 days and hence must be changed every 28 days. If a password is not reset within the 28 day window, a call must be logged with the helpdesk who will reset it. If a password it not used for 6 months, the user account expires and a new account must be applied for using the clinical audit form. At what point should the Performance Status be recorded? The Performance Status should be recorded at the point in time closest to the start of treatment. It should be updated if it differs from the original Performance Status entered. Is there a proforma I can use to help me collect the audit data? A proforma is available in the downloads section. As well as the full audit dataset it also highlights the key fields that are essential for the audit. What data should be entered into data field 5.5 (Cancer Care Plan Intent)? There has been uncertainty around the correct interpretation of this field. This is partly due to conflicting data definitions between LUCADA and Cancer Waiting Times and partly due to differences in data definitions between lung cancer and mesothelioma. Data Field 5.5 CANCER CARE PLAN INTENT should be used to record the intention of the treatment which is planned for the patient at this point in time.
Intent Plan Details Curative (C) Surgical resection (including open and close' but excluding all surgery on mesothelioma patients) Radical radiotherapy to primary site with potential for cure Chemotherapy in Limited Stage and/or Good Prognosis Small Cell Carcinoma (e.g. using Manchester' prognostic score) Adjuvant (or neo-adjuvant) chemotherapy (combined with surgery) in Non-Small Cell Carcinoma Adjuvant radiotherapy in Small Cell carcinoma Prophylactic Cranial Irradiation Palliative (P) Specialist Palliative Care Chemotherapy in Non-Small Cell Carcinoma (excepting Adjuvant and Neo-adjuvant therapy) Radiotherapy to primary tumour with palliative intent Radiotherapy to site of secondary cancer Brachytherapy (Endobronchial radiotherapy) Other endobronchial treatments (e.g. laser therapy, diathermy, cryotherapy, insertion of bronchial stent) Chemotherapy in Extensive Stage and/or Poor Prognosis Small Cell Carcinoma (e.g. using the Manchester' prognostic score) Surgery for mesothelioma (EPP, debulking surgery and pleurodesis) Surgical Pleurodesis Superior Vena Caval Stenting Palliative - supportive care only (S) This item implies follow up with the aim of identifying symptoms and treating these if and when appropriate. Follow up could be through primary care, secondary care and includes doctors, nurses and Macmillan staff. The plan implies that no immediate treatment is to be given but does not exclude the patient from having treatment at a future date if the need arose. No specific anti-cancer treatment (N) Unknown (9) It is highly unlikely that any treatment plan would be drawn up, where the intention of the treatment is Unknown. The use of this code should be carefully monitored. Important messages: All surgery in mesothelioma patients is to be classified as palliative (P) Pleurodesis, whether medical or surgical, is to be classified as palliative (P)
EXAMPLES: 5.5 Scenario C Patient has clinical or histological diagnosis of lung cancer undergoes surgery with curative intent. P Patient has clinical or histological diagnosis of mesothelioma - undergoes EPP, debulking or surgical pleurodesis. P Patient has clinical or histological diagnosis of lung cancer - undergoes surgical or medical pleurodesis. C Patient has clinical or histological diagnosis of lung cancer - undergoes potentially curative chemotherapy and also has surgical or medical pleurodesis. In the latter example, the pleurodesis is recorded as a palliative care intervention in sections L41/L42. What data should be entered into data field L29 (Treatment Planned)? There has been uncertainty around the correct interpretation of these fields. This is partly due to conflicting data definitions between LUCADA and Cancer Waiting Times and partly due to differences in data definitions between lung cancer and mesothelioma. Data Field L29 (TREATMENT PLANNED) should be used to record the type of treatment regimen planned. Code Treatment 01 Surgery For Lung Cancer patients (including clinical diagnoses) - record here any surgical procedure under taken with the intention of curing the patient.do not record here any procedures undertaken for purely diagnostic purposes these should beentered in the Care Plan / MDT section. For Mesothelioma patients - it is accepted that all surgical procedures in this group of patients are palliative. Please enter any therapeutic procedures as surgery other (E57.8). Do not record here any procedures undertaken for purely diagnostic purposes these should be entered in the Care Plan / MDT section. 02 Teletherapy / Radiotherapy
03 Chemotherapy 04 Brachytherapy 05 Palliative care 06 Active Monitoring 07 Sequential chemotherapy and radiotherapy 08 Concurrent chemotherapy and radiotherapy 09 Induction chemotherapy to downstage before surgery 10 Neo-adjuvant chemotherapy and surgery 11 Surgery followed by adjuvant chemotherapy EXAMPLES: L29 Scenario 01 Patient has clinical or histological diagnosis of lung cancer undergoes surgery with curative intent. 01 Patient has clinical or histological diagnosis of mesothelioma - undergoes EPP, debulking or surgical pleurodesis. 05 Patient has clinical or histological diagnosis of lung cancer - undergoes surgical or medical pleurodesis. 03 Patient has clinical or histological diagnosis of lung cancer - undergoes potentially curative chemotherapy and also has surgical or medical pleurodesis. In the latter example, the pleurodesis is recorded as a palliative care intervention in sections L41/L42.