Lung NSSG Annual Report 2011/12 Agreement Cover Sheet

This Annual Report has been agreed by: Lung NSSG Annual Report 2011/12 Agreement Cover Sheet Position: Name: Chair of the NSSG Dr Duncan Powrie Organisation: Date Agreed: 9 th May 2012. Southend University Hospitals NHS Foundation Trust Position: Name: Chair of the Network Board Sheila Bremner Organisation: NHS North Essex Cluster. Date Agreed: 15 th May 2012 1

Category Introduction Report Lung Cancer Network Site-Specific Group Annual Report 2011/12 This annual report from the Lung NSSG covers the period 1 st April 2011 to 31 st March 2012. Key achievements in 2011/12 include: Agreement of local Rehabilitation Pathway for people with lung cancer. Embedding network audit within the NSSG. Taking an active role in the ILCOP. NSSG Meetings Schedule / Attendance (11-1c-101g) There have been 3 Lung NSSG business meetings during 2011/12 plus one audit event. In Addition the clinical guidelines sub group met to review the clinical guidelines. Appendix 1 presents the attendance summary for the meetings that have taken place during 2011/12. All the minutes for 2011/12 NSSG meetings are collated in Appendix 2 The summary clearly demonstrates attendance and involvement from core members of each of the Lung MDTs within the Network. Network Configuration The Network Lung Cancer NSSG consists of members of a multi-disciplinary background coming from the 4 acute hospital Trusts: Basildon Hospital (including ECTC), Broomfield Hospital, Colchester Hospital and Southend Hospital. The Group is supported by the Network Director and her team. This year we have secured the involvement of a primary care representative and a second user representative. Basildon and Southend Hospitals operate a combined MDT and meetings are held on a weekly basis via telemedicine link. This MDT also functions as a specialist mesothelioma MDT. Colchester and Broomfield Hospitals have their own separate MDT meetings on a weekly basis. Both MDTs also function as a mesothelioma specialist MDT. The Consultant Cardiothoracic representatives attend all the lung cancer MDT meetings within the Network. Activity and waiting times Overview Number of patients discussed at MDT April 2011 to Jan 2012. Export full screen.jpg Waiting time data: 2011-12 Lung 2WW 31 Day 62 Day No. % No. % No. % BASILDON 286 97.28% 188 99.47% 81 79.80% CHELMSFORD 217 97.75% 88 100.00% 39 83.87% COLCHESTER 341 99.71% 212 99.07% 104 90.43% SOUTHEND 323 97.88% 280 99.64% 131 79.88% Grand Total 1167 98.23% 768 99.48% 355 83.14% Annual Review (11-1c-102g) The chair s annual review was carried out in 2011/12 by Mr Tom Carr the then ECN Medical Director. Date: 29 th June 2011. 2

Network Audit (11-1c-108c) The NSSG annual audit event was held on 16 th March 2012. Audits presented are embedded below. Overview of the Local/National NLCA Data NLCA Essex 16 03 12 slides 2010 results.pptx Chemotherapy for Small Cell Lung Cancer yung Slides small cell lung cancer audit 04 03 2012.ppt Surgical Treatment for Patients with Stage I and Ii Lung Cancer Diagnosed In 2011 LungCancerAuditFina l.ppt PET scanning and histological confirmation duncan Essex Cancer Network PETCT audit.ppt Actions agreed following Audits 1. Overview of the Local/National NLCA Data- agreed to focus on key outcome measures such as surgical resection rate and chemotherapy rate as subjects for yearly audit. 2. Chemotherapy for Small Cell Lung Cancer- ensure that all patients with a performance status of 3 and above are seen by an oncologist and that the time from decision to treat to chemotherapy is as short as possible. If the patient is deemed borderline in terms of fitness they should be offered the opportunity to see an oncologist. It was agreed that the reasons for many patients declining chemotherapy when offered would be investigated. It was agreed to look at outcomes for patients treated with chemotherapy particularly those with poor performance status. 3. Surgical Treatment for Patients with Stage I and Ii Lung Cancer Diagnosed In 2011- this area will become a focus for annual audit. All patients with stage I and II disease will have a full work-up with assessment of fitness for surgery including full PFTs and CPEX if appropriate to ensure that nobody is turned down inappropriately on grounds of fitness. Patients of borderline fitness will have the opportunity to see a cardiothoracic surgeon to discuss the risks and benefits of surgery prior to a final decision on fitness 3

being made. 4. PET scanning and histological confirmation. Sampling of mediastinal nodes that were positive on PET CT was carried out in all cases where it was clinically appropriate. This practice should continue. There were large numbers of PET scans that were suggestive of distant metastases and the histological confirmation rate of these was low. It was agreed that efforts should be made to confirm histologically the presence of metastatic disease that is only evident on PET scan. Clinical lines of enquiry Service Improvement Clinical lines of enquiry data for the NSSG are given in appendix 4. There is an active CNS forum which leads on service improvement. Two Study highly successful study days were organized by the group. The one covering NE and Mid Essex was very well attended with an excellent cross section of attendees including GPs. The one covering the South was well attended but did not have any GPs. Patient & Carer Feedback and Involvement As part of the ILCOP a patient experience survey was conducted. The results of the survey are embedded below. FINAL ILCOP patient experience report Basildon Southend 2012.xlsx Agreed actions as a result of this audit included: 1) ensure that all patients are offered a copy of their clinic letters 2) Involve the lung CNS prior to diagnosis to help explain tests and support the patient through the pathway. The NSSG has now recruited 3 patient representatives to the group. Minimum Data Sets (11-1c-107c) The 4 acute Trust leads have further confirmed their commitments to continue to upload data to the LUCADA national audit dataset. High levels of compliance have been achieved for all four acute trusts. National Lung Cancer Audit 2011 ( for patients diagnosed in 2010) % of expected cases on whom data is recorded % Histological confirmation rate % having active treatment Basildon Colchester Mid Essex Southend 114 148 114 105 82.5 81.9 81.7 72.8 56.5 72.3 66 55 4

% undergoing surgical resection (all cases excluding mesothelioma) % small cell lung cancer receiving chemotherapy 10 10 11.8 6.4 44.4 79.3 72.7 50 Attendance at Lung NSSG 2011/12 Name Title ORG 8.7.2011 30.9.2011 10.2.2011 Appendix 1 Audit 16.3.12 % North East Essex Annette Brown Lung CNS CHUFT Yes 25 Samantha Cooper Chest Physician CHUFT Yes Yes Yes Yes 100 Will Howard Radiologist CHUFT Yes Yes Yes Yes 100 Julia Harris (from 12/11) Radiologist CHUFT N/A N/A Yes Yes 100 Kate Fitzgerald Lung CNS CHUFT Yes 25 Sunil Skaria Oncologist CHUFT Yes Yes 50 James Murray Chest SpR CHUFT Yes Yes 50 Atil Gulati Chest Physician CHUFT Yes 25 Paul Conn Histopathologist CHUFT Yes 25 Mid Essex David Blainey Chest Physician MEHT Yes No Yes 66 Kiran Kancherla Oncologist MEHT Yes No 25 Steve Jenkins Chest Physician MEHT Yes Yes 50 Liz Butler Lung CNS MEHT No Yes Yes 50 A Kempalingaigh Histopathologist MEHT Yes 25 South Essex Southend Mandip Khaira ( from 2012) Oncologist SUHFT Yes 50 Jolly Barber Lung CNS SUHFT Yes Yes Yes 75 Shafali Jain Radiologist SUHFT Yes 25 Michelle Palmer SUHFT Yes 25 Johanna Phelps Lung CNS SUHFT Yes Yes 50 Duncan Powrie ( Chest Physician SUHFT Yes Yes chair) YES Yes 100 Olivia Chan(from Oncologist SUHFT 2012) Yes No 50 South Essex Basildon Filomena Medeiros Pathologist BTUHFT Yes Yes 50 5

Beverly Waker Lung CNS BTUHFT Yes Yes Yes 75 Catherine O Doherty Palliative care BTUHFT consultant No Doug Aitchison Cardiothoracic BTUHFT Yes Surgeon 25 Dr. Bernard Yung Chest Physician BTUHFT Yes Yes Yes 75 Michelle Hastings Lung CNS BTUHFT Yes Yes Yes 75 Samir Shah Cardiothoracic Surgeon BTUHFT No Yes Yes 50 GP representation Dr Liz Towers GP Mid (from 2012) Essex Yes No 50 User Representation Ian Steele User ECN Yes No Yes NO 50 Michael Scanes User Facilitator ECN No Yes Yes No 50 Mervyn Cottenden User (from 2012) ECN Yes No Tony Howes User (from 2012) ECN YES No Cancer Network Sue Maughn Network Director ECN Yes No Yes Yes 75 Kate Patience AHP lead ECN No Yes Yes 50 Carol O Leary Nurse Director ECN Yes No 25 Netty Wood Lead Pharmacist ECN Yes 25 Essex Cancer Research Network Ashley Solieri Manager ECRN Yes Yes 50 50 50 6

Essex Cancer Network Lung Cancer NSSG Friday 8 th July 2011 2:00pm-4:00pm Swift House Board Room Minutes Present: Duncan Powrie (chair) DP Consultant Chest Physician, SUHFT Dr Samantha Cooper SC Consultant Chest Physician, CHUFT Ian Steele IS Patient Representative Fiona Peskett FP Head of Acute Commissioning, NHS SWE Sue Maughn SM Network Director, ECN David Blainey DB Consultant Chest Physician, MEHT Bernard Yung BY Consultant Chest Physician, BTUHFT Kiran Kancherla KK Consultant Clinical Oncologist, MEHT Ashley Solieri AS Research Manager, ECRN Kate Fitzgerald KP Macmillan AHP Lead, ECN Will Howard WH Radiologist, CHUFT Jolly Barber JB Lung Cancer CNS, SUHFT Beverly Walker BW Lung Cancer CNS, BTUHFT Michelle Hastings MH Lung Cancer CNS, BTUHFT Carol O Leary COL Nurse Director, ECN 7

Wendy Jeffreys WJ Public Health Improvement & Partnership Manager 1. Apologies Belinda Grant, Paul Conn, Kate Patience, Annette Brown, Jackie Gibson, Liz Butler, Pam Green, Jo Phelps, Doug Aitchinson,Sunil Skaria, Dr Gulkati Welcome to Dr Will Howard- Radiologist CHUFT. 2. Previous Minutes 18 th February 2011 Accepted as a true record of the meeting. 3. Matters Arising 3.1 NAEDI project update Wendy Jeffries and Fiona Peskett were in attendance. WJ provided the NSSG with an update. The Get it off Your Chest ECN Lung Cancer Awareness Campaign had been launched at 2 venues, Clacton and Aveley. Thanks were extended to those NSSG members who had attended the events and who have taken part in the campaign, which will run until the end of July. It is being fronted by 3 lung cancer survivors from Essex. A post campaign survey will be conducted. The Project Team would like to present initial findings to the NSSG in October. 3.2 Peer Review 2011 Lung Teams are only required to self assess and produce a self assessment report this year. There is no requirement to upload supporting documentation. SM suggested that it might still be useful to upload the documents because they might be of interest to members of the public once published. The local MDT in South Essex is exempt from the process this year. Lung Constitution: This was reviewed in February when new Mesothelioma Guidelines were added. A small subgroup of the NSSG will be established to review the Guidelines. SM to facilitate. Action: SM Annual Report: 8

The Annual Report was reviewed in real time by the group; having previously been circulated. A few adjustments were made. Following these amendments the Annual Report was approved. Work Programme: This had been approved previously. 3.3 LUCADA 2010 RESULTS A copy of the Audit Report has been previously circulated and some of the content has been used within the NSSG Annual Report. Data completeness excellent. Histology rate had been subject to audit this year. High rate of patients seen by a CNS at diagnosis. There was some discussion about practices in relation to a CNS being present when an inpatient is given a diagnosis. It was suggested that some of the LUCADA datasets should provide standard audits that can be repeated every 2 years. 3.4 AUDIT 2012 Suggested a re-audit of some topics done 2 years before as suggested above. Small cell chemo rates Resection rates Management of early stage disease (stages 1 and 2 and N2 ) SM enquired if anyone had used cyber knife for this patient group as it had been suggested that it could be useful in this patient group where they might be medically inoperable. Patient satisfaction survey MEHT carer s survey. Review of non-surgical practice for stage 3 disease.(use of concurrent chemo and RT) 3.5 Research Network and Clinical Trials AS reported that BY had written to MDT Chairs with list of studies for comment and approval and had only received one reply. AS to re-send on behalf on the Chair. The current list of studies and recruitment were discussed and it was highlighted that there are referrals to Basildon for the MESOVATS trial and this should be reflected in the reports. It was also 9

agreed that the MDT proformas should include a reference to clinical trial suitability. 3.6 CTC Update Nothing to report 3.7 Palliative Care Services Update The Network is working through the implementation of the NICE Guidance on SPC. The roll out of Patient Information is ongoing and the Rehab Pathways are being incorporated in to the specific NSSG s. Access to psychological support is variable across the Network. DB reported that access to this type of support is restricted to patients who meet certain criteria. 3.8 CNS Update The CNS s are in the process of organising a study day in November. The Patient Satisfaction Survey is to be re-run during July. Questionnaires are currently being distributed. The CNS forum is meeting 4 times a year. 4. Any Other Business 4.1 Sign off of Rehab Pathways The Rehab Pathways had previously been circulated to the group and required approval. SM reminded the group that the purpose of the pathways was that they can be used to trigger a referral to a number of different AHP s dependent on the requirements of the patient at that given time. They will be added to the next revision of the constitution. 4.2 Teenager and Young Adults Final Peer Review Measures have been released today. For SA and IV by the 15 th December. 4.3 Management of SPN s Will Howard to lead on a review of the guidance that can be incorporated in to the next revision of the Constitution. Action: WH 10

4.4 Oncologist Attendance Attendance of oncologists at the group had been patchy. SM suggested that this is problematic in some of the other groups. TC to write to lead oncologists for all NSSG s. Action: TC 5 Dates of future meetings All 2pm-4pm unless otherwise stated Friday 30 th September - Friday 10 th February 2012 Friday 29 th June 2012 Friday 19 th October 2012 Swift House, Middle and Annexe. Swift House, Board & Middle Swift House, Board & Middle Swift House, Board & Middle Audit Friday 16 th March 1.pm- 4:30pm Essex Cancer Network Lung Cancer NSSG Friday 30 th September 2011 1.15pm -4:00pm Essex County Cricket Ground Chelmsford Minutes Present: 11

Dr. Duncan Powrie (chair) DP Consultant Chest Physician, SUHFT Dr Samantha Cooper SC Consultant Chest Physician, CHUFT Liz Butler LB Lung Cancer CNS, MEHT Dr Steve Jenkins SJ Chest Physician, MEHT Dr. Sunil Skaria SS Consultant Oncologist, CHUFT Sian Gibson SG Oncology Research Nurse, MEHT Dr Bernard Yung BY Consultant Chest Physician, BTUHFT Michelle Hastings MH Lung Cancer CNS, BTUHFT Jolly Barber JB Lung Cancer CNS, SUHFT Kate Patience KP Macmillan AHP Lead, ECN Will Howard WH Radiologist, CHUFT *Dr Kishor Padki KP Public Health Medicine Consultant, SWEPCT *Carole Horn CH NAEDI Coordinator, SWEPCT *Dr Liz Towers LT Macmillan GP, Mid Essex *Colin Cornforth CC COI *Wendy Jeffreys WJ Public Health Improvement & Partnership Manager *NAEDI Presentation Only 1. Apologies: Paul Conn, Kate Patience, Annette Brown, Jo Phelps, Doug Aitchinson,Sunil Skaria, Dr Gulati, David Blainey, Keith Hattotowa, Tom Carr, Linda Underwood, Ashley Solieri, Andrew Richie, Donna Booton, Ann Stock, Beverley Walker, Catherine O Doherty, Ian Steele, Sue Maughn, Annette Anil, Shaifali Jain, Samir Shah 2. Previous Minutes 8 th July 2011 Dr Gulati s name had been misspelt on the previous minutes. With this correction they were accepted as a true record of the meeting. 3. Matters Arising 12

3.1 NAEDI project update Colin Cornforth from the COI attended the meeting to discuss the evaluation of the Lung Cancer awareness project. Campaign Objectives: To increase awareness of lung cancer amongst at-risk groups To increase the number of at-risk groups presenting to GP with symptoms To encourage health care professionals to have proactive discussions with at-risk groups. Target audience for campaign: Current and ex-smokers 45+ males and females (with a male bias) C2, D, Es in most deprived areas Influencers family /friends and community stakeholders (secondary) Focus: Southend, Canvey Island, Basildon, Thurrock, Colchester, Clacton-on-Sea, Braintree and Chelmsford The aim of the session was to identify stories, experiences and practical examples of where and how the lung cancer campaign had impacted upon patients, primary and secondary care. No one at the meeting could recall having seen any of the posters. LT was the only GP present and could not comment on whether there had been an increase in patients being referred. SC said that at Colchester there had been 1500 more GP referrals from GPs for X-rays and a similar increase in 2 week wait referrals however the number of Lung Cancers diagnosed had actually fallen. 3.2 Peer Review 2011 The NSSG and the MDTs had completed Self-assessments only for this round of Peer Review. SC said that this exercise was a waste of her time as the process was just repeating the information supplied in the Constitution, Annual Report and Work Programme. DP said that the Clinical Guidelines should probably be updated and suggested a small sub group should convene to do this work. It was agreed that the group would include: DP, SC, SS, WH, Jo Phelps and a surgeon. 3.3 LUCADA 2010 RESULTS 13

DP said that ECN were the second best network in England with respect to data completeness. He added that it was a little worrying that surgical resection rates at Southend had fallen from 11% to 6%. LB said that they were actually increasing for MEHT patients. 3.4 AUDIT 2012 It was agreed to include the following topics at the 2012 Audit meeting: 1. Chemotherapy for Small Cell Lung Cancer Bernard Yung 2. Appropriateness of treatment for Stage I and II disease- Samantha Cooper. 3. PET scanning and histological confirmation Shaifali Jain / Duncan Powrie 4. Patient Satisfaction- Michael Scanes The Audit meeting is scheduled for 16 th March 2012 from 1pm to 4pm. (Venue to be advised) 3.5 Research Network and Clinical Trials No discussion due to absence of Ashley Solieri Research Manager 3.6 CTC Update The CTC have appointed a Pathologist 3.7 Palliative Care Services Update Nothing to report as no Palliative Care representative present. 3.8 CNS Update CHUFT and MEHT CNSs have organised a study day in November. There were currently 45 delegates registered out of a maximum of 50 places. KF said that there were several GPs registered which was thanks to Tara Large in the Network Office who had circulated details to all GP Practices across Essex. MS was currently re drafting the Patient Satisfaction Survey to include questions on Holistic Needs assessment and to clarify the question on Nurse led Clinics. The survey will be conducted over the next couple of months. JB said that the Southend and Basildon Nurses were in the process of planning a study day. 4. Any Other Business 14

4.1 Lung Cancer Treatment Algorithms Treatment Algorithms for Lung Cancer had been circulated and approval of the group was required. The algorithms are based on NICE TAs. DP questioned whether they had been discussed and approved by the Network Chemotherapy Board? SS said that he would discuss with Netty Wood (Pharmacist) and report back to the next meeting. Discussion and approval were deferred to the next meeting. 4.2 Primary Care Representation: DP said that Dr Liz Towers who had attended first part of the meeting had agreed to join the NSSG as a Primary Care representative. MS said that he had received a letter from Ian Steele advising that his GP Dr David Tideswell had also agreed to join the group. He added that Ian had been undergoing intensive treatment over the summer which had prevented him attending meetings he was planning to resume his membership at the next meeting. 5 Dates of future meetings for 2012 All 2pm-4pm unless otherwise stated Middle and Annexe, Swift House Friday 10 th February 2012 Friday 29 th June 2012 Friday 19 th October 2012 Audit - Friday 16 th March 1.00 pm- 4:30pm venue to be confirmed. Essex Cancer Network Lung Cancer NSSG Friday 10 th February 2012 15

2.00pm -4.00pm Swift House, Middle & Annexe Minutes Present: Dr Duncan Powrie (chair) DP Consultant Chest Physician, SUHFT Dr Samantha Cooper SC Consultant Chest Physician, CHUFT Dr David Blainey DB Consultant Chest Physician, MEHT Ian Steele IS Patient Dr Sunil Skaria SS Consultant Oncologist, CHUFT Kate Patience KP Macmillan AHP lead, ECN Dr Shaifali Jain SJ Radiologist, SUFHT Michelle Hastings MH Lung Cancer CNS, BTUHFT Annette Brown AB Lung Cancer CNS, CHUFT Beverly Waker BW Lung Cancer CNS, BTUHFT Will Howard WH Radiologist, CHUFT Michael Scanes MS User Involvement Lead, ECN Mandip Khaira MK Consultant Clinical Oncologist, SUFHT Dr Liz Towers LT Macmillan GP, Mid Essex Filomena Medeiros FM Consultant Pathologist, BTUHFT Mervyn Cottenden MC Ex-Patient Tony Howes TH Ex-Patient Ashley Solieri AS Research Network Manager, ECRN Sue Maughn SM Network Director, ECN Julia Harris JH Radiologist, CHUFT Mr Samir Shah SSh Consultant Thoracic Surgeon, BTUHFT Dr Olivia Chan OC Oncologist Dr James Murray JM Respiratory SpR Netty Wood NW Network Pharmacist 16

1. Apologies: Sian Gibson, Johnson Samuel, Dr D K Mukherjee, Atul Gulati, Catherine O Doherty, Paul Conn, Michelle Palmer, Keith Hattotuwa, Rachael West, Steve Ashdown, Dr K. Kancherla, Jolly Barber, Tom Carr 2. Previous Minutes 8 th July 2011 Agreed as an accurate record of the previous meeting. 3. Matters Arising 3.1 Network Guidelines: NW said that the Clinical Guidelines need to be updated with the appropriate Chemotherapy regimens. The text should follow the flow chart. DP said that the last version, which had been circulated for approval, was not in fact the latest version. He added that it needed an Oncology update. DP et al will revise and circulate so that they can be signed off at the audit meeting. SM said that she will do the same for the three year work programme. 3.2 Peer Review 2012 Due to the number of new services receiving a Peer Review visit this year, the Lung MDTs and NSSG will not receive a visit this year. The teams will need to do a Self-assessment by 30 th September 2012 only. (NO Internal Validation). 3.3 LUCADA 2010 RESULTS All Trusts are now submitting data to LUCADA. Almost 100% of Lung Cancer patients are now reported. The LUCADA report allows a comparison of Local performance with National performance. DP said that ECN were the second best Network in England with respect to data completeness. Treatment rates: National 58% - ECN 62% Surgical Resection rate: National 13.7% ECN 9.4% NSCLC: National18.3% ECN 14.5% 17

Patients diagnosed with Stage 4 disease: National 43% ECN 52% Patients in Essex generally present later with stage 4 disease. CTC believe that LUCADA under reports surgery. If the units send the numbers of patients suitable for surgery, they will check the numbers against LUCADA to see how many are not included. DP said that the units need to identify patients suitable for surgery, work them up and get as many as possible sent for surgery. DB suggested that we produce data which shows that all suitable patients are being referred for surgery. DP said that we should request an external review to check that what we are doing is correct. IS asked if they were trying to justify what they are doing is correct? DP replied that all patients should receive surgery if they are fit enough. DP said that ECN Chemotherapy rates and Chemo/Radiotherapy rates were higher than National figures. It was noted that patients with suspected Lung cancer should be referred for a CT Scan prior to a Bronchoscopy. 3.4 NAEDI Update LT said that the ECN NAEDI (National Awareness and Early Diagnosis Initiative) group are looking at raising awareness of a number of cancer types, including lung. DP asked how we could get patients present earlier. There had been a selective campaign in summer 2011 which included bill board posters and advertisements at bus stops etc. Colchester had seen an increased number of referrals but no increase in the number of diagnoses. Southend had seen no change in referral rates. SM said that the message was that we should keep drip feeding the awareness messages rather than having an intensive 6 week campaign. The ECN Board have requested information on what the group is doing to increase smoking cessation. BW said that patients report that they visit their GP several times with symptoms before they are referred, so it must be about raising the awareness of GPs as well as the public. LT said that there were no GPs in Mid Essex who were aware of the campaign. MC said that he had a bad chest in 2007 which was treated with antibiotics for two months. The GP then decided that it was asthma. Eventually he went to MEHT where he had an X-ray and was diagnosed with Lung Cancer. DP asked how we raise awareness among the GP Community. SM said that the Network had run a Pharmacy Project concentrating on raising awareness of Colorectal, Skin and Lung cancers, which had increased conversations between patients and pharmacists around symptoms. This Project has been followed up with an e-learning project. About 100 pharmacies in Essex had signed up to the Project. She added that there was still some money left in the budget and we could consider advertising on buses. 18

IS thought that this would be a waste of money. DP suggested that it would be better to focus on GP practices. LT said that there are 3 or 4 education projects across the Network. She added that the training has to be GP led as GPs will not be interested if it is Public Health led. It was suggested that GPs should have targeted screening of patients with symptoms and it was agreed that the group should write to GPs and tell them about the audit and advise them to refer ALL patients with symptoms SM said that the DH were running a Lung Awareness Pilot somewhere in England and if successful would be rolled out across the country as they have done with the Bowel Cancer Campaign. DP said that in Leeds, GPs who referred patients for the lowest number of chest X Rays were targeted with awareness information. 3.5 Research Network and Clinical Trials As reported that as Tim Crook was leaving Southend, a new Research Lead for the NSSG was required. AS will circulate a list of current trials. She added that the NSSG should establish a sub group to look at research studies and report back to the NSSG. She will be writing to all NSSG chairs to formally make this suggestion. The MDT proforma has a box fit for research but it is not necessarily adhered to. Portfolio maps available on www.ncrn.org.uk Action: AS 3.6 CTC Update No update 3.7 Palliative Care Services Update Nothing to report as no Palliative Care representative present. 3.8 CNS Update Kate Fitzgerald has now left CHUFT and they are actively recruiting a replacement. BW is moving out for 6 months to concentrate on another role in the Trust. 19

Two Study days had been held recently. The one covering NE and Mid Essex was very well attended with an excellent cross section of attendees including GPs. The one covering the South was well attended but did not have any GPs. There had been a good feedback from both events. 4. Any Other Business 4.1 GP Engagement DP welcomed LT to the meeting. She said that she hoped that the other two Macmillan GPs would attend future meeting (Linda Mahon-Daly from NE Essex and Rajan Mohile from South Essex) SM commented that generally GP engagement in NE Essex was good, Mid Essex, Fair and South Essex poor. 4.2 David Blainey DP said that David was retiring shortly and wished him a long and happy retirement. 5 Dates of future meetings for 2012 All 2pm-4pm unless otherwise stated Board & Middle, Swift House Friday 29 th June 2012 Friday 19 th October 2012 Audit - Friday 16 th March 1.00 pm- 4:30pm Writtle College, CM1 3RR 20

Appendix 3 Essex Cancer Research Network Lung Cancer Trials and Recruitment 2011/12 Trial Name and Short Description CONVERT - A 2-arm randomised controlled trial of concurrent chemoradiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer (SCLC) and good performance status ET Trial - A multicentre, randomised, phase III trial of platinum-based chemotherapy versus non-platinum chemotherapy, after ERCC1 stratification, in patients with advanced/metastatic non-small cell lung cancer FRAGMATIC - A randomised phase III clinical trial investigating the effect of FRAGMin Added to standard Therapy In patients with lung Cancer (Closed July 2011) LungStar - A multicentre phase III randomised double blind placebo controlled trial of pravastatin added to first-line standard chemotherapy in patients with small cell lung cancer (Closed December 2011) Time1 - The First Therapeutic Intervention in Malignant Pleural Effusion Trial (TIME1): A 2 x 2 factorial trial to assess whether non-steroidal antiinflammatory analgesics and small bore chest tubes are less painful than opiate analgesics and a large bore chest tubes in pleurodesis for malignant pleural effusion. Southend Basildon Chelmsford Colchester 2011/12 recruitment Total 2011/12 recruitment 4 19 Total 2011/12 recruitment 0 3 Total 2011/12 recruitment Total 0 9 1 10 MALCS - A population based case-control study of mesothelioma and lung cancer in relation to occupation among British men and women 6 12 3 30 0 13 6 37 MESOVATS - Prospective randomised controlled trial of video-assisted thoracoscopic (VATS) cytoreductive pleurectomy compared to talc pleurodesis in patients with suspected or proven malignant Refer to BTUHFT 2 8 27 Refer to BTUHFT Refer to BTUHFT 21

mesothelioma. Modafinil for Fatigue in Lung Cancer - A multicentre, randomised, double-blind, placebo controlled trial 0 6 QUARTZ - A phase III multicentre randomised controlled trial to assess whether optimal supportive care (including dexamethasone) alone is as effective as optimal supportive care (including dexamethasone) and whole brain radiotherapy (WBRT) in the treatment of patients with inoperable brain metastases from non-small cell lung cancer (NSCLC). 0 0 Total 6 14 15 82 0 25 7 47 22

DRAFT Essex Cancer Network: Lung Clinical Lines of Enquiry 2012-2013 Metric 1: The percentage of expected cases on whom data is collected Original Table 1a - % of expected 2,000.0 1,800.0 1,600.0 1,400.0 1,200.0 1,000.0 800.0 600.0 400.0 200.0 0.0 Original Table 1a Data completeness for key fields England and Wales Original Table 1a - % of expected 160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 RDE RDD RQ8 RAJ Original Table 1a Data completeness for key fields England and Wales 23 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Changes from 2010 LUCADA Report to 2011 LUCADA Report Percentage Growth Original Table 1a - % of expected 200.0% 150.0% 100.0% 50.0% 0.0% -50.0% -100.0% -150.0% Original Table 1a Data completeness for key fields England and Wales Original Table 1a - % of expected 8.0% 6.0% 4.0% 2.0% 0.0% -2.0% RDE RDD RQ8 RAJ -4.0% -6.0% -8.0% -10.0% Original Table 1a Data completeness for key fields England and Wales 24 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Metric 2: The % histological confirmation rate (NB See also Case Mix Adjusted Odds Ratio [OR]) Original Table 2a - Histological diagnosis (%) 120.0 100.0 80.0 60.0 40.0 20.0 0.0 Original Table 2a Process and clinical outcomes England and Wales Original Table 2a - Histological diagnosis (%) 84.0 82.0 80.0 78.0 76.0 74.0 72.0 70.0 68.0 66.0 RDD RDE RQ8 RAJ Original Table 2a Process and clinical outcomes England and Wales Changes from 2010 LUCADA Report to 2011 LUCADA Report 25 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Percentage Growth Original Table 2a - Histological diagnosis (%) 400.0% 350.0% 300.0% 250.0% 200.0% 150.0% 100.0% 50.0% 0.0% -50.0% -100.0% -150.0% Original Table 2a Process and clinical outcomes England and Wales Original Table 2a - Histological diagnosis (%) 20.0% 15.0% 10.0% 5.0% 0.0% RAJ RDD RDE RQ8-5.0% -10.0% -15.0% Original Table 2a Process and clinical outcomes England and Wales Metric 3: The percentage having active treatment(nb See also Case Mix Adjusted OR) 26 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Original Table 2a - % Having active treatment 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Original Table 2a Process and clinical outcomes England and Wales Original Table 2a - % Having active treatment 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 RDE RQ8 RDD RAJ Original Table 2a Process and clinical outcomes England and Wales Changes from 2010 to 2011 reports 27 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Original Table 2a - % Having active treatment 4.0% 2.0% 0.0% RQ8 RAJ RDE RDD -2.0% -4.0% -6.0% -8.0% Original Table 2a Process and clinical outcomes England and Wales Metric 4:The percentage undergoing surgical resection (all cases excluding Mesothelioma & confirmed Small Cell Lung Cancer) (NB See also Case Mix Adjusted OR) Table 17c - All NSCLC patients receiving surgery (%) 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Table 17c All NSCLC & histologically confirmed NSCLC patients receiving surgery by trust 28 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Table 17c - All NSCLC patients receiving surgery (%) 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 RQ8 RDE RDD RAJ Table 17c All NSCLC & histologically confirmed NSCLC patients receiving surgery by trust Changes from 2010 LUCADA Report to 2011 LUCADA Report Percentage Growth Original Table 2a - % of NSCLC having Surgery 40.0% 30.0% 20.0% 10.0% 0.0% RQ8 RDD RDE RAJ -10.0% -20.0% -30.0% -40.0% Original Table 2a Process and clinical outcomes England and Wales 29 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Metric 5: The percentage of small cell cancer patients receiving chemotherapy (NB See also Case Mix Adjusted OR) Original Table 2a - % small cell receiving chemotherapy 120.0 100.0 80.0 60.0 40.0 20.0 0.0 Original Table 2a Process and clinical outcomes England and Wales Original Table 2a - % small cell receiving chemotherapy 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 RDE RQ8 RAJ RDD Original Table 2a Process and clinical outcomes England and Wales Changes from 2010 LUCADA Report to 2011 LUCADA Report Percentage Growth 30 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc

DRAFT Original Table 2a - % small cell receiving chemotherapy 30.0% 20.0% 10.0% 0.0% RQ8 RDE RAJ RDD -10.0% -20.0% -30.0% -40.0% -50.0% Original Table 2a Process and clinical outcomes England and Wales Trust Code Key N38 RAJ RDD RDE RQ8 Essex Cancer Network Southend University Hospital NHS Foundation Trust Basildon and Thurrock University Hospitals NHS Foundation Trust Colchester Hospital University NHS Foundation Trust Mid Essex Hospital Services NHS Trust 31 of 31 N:\NSSG Peer review docs\2012\lung\lung Annual Report 2011-12 FINAL for ECNB.doc