ABSTRACT
Since 2014, the National Lung Cancer Audit (NLCA) has been evaluating the performance of the UK NHS lung cancer services against established standards of care. Prior to the onset of the COVID-19 pandemic, the NLCA's annual reports revealed a steady stream of improvements in early diagnosis, access to surgery, treatment with anti-cancer therapies, input from specialist nursing and survival for patients with lung cancer in the NHS. In January 2022, the NLCA reported on the negative impact COVID-19 has had on all aspects of the lung cancer diagnosis and treatment pathway within the NHS. This article details the fundamental changes made to the NLCA data collection and analysis process during the COVID-19 pandemic and details the negative impact COVID-19 had on NHS lung cancer patient outcomes during 2020.
Subject(s)
COVID-19 , Lung Neoplasms , COVID-19/epidemiology , Humans , Lung , Lung Neoplasms/epidemiology , Lung Neoplasms/therapy , PandemicsABSTRACT
Introduction: Optimal treatment of stage III-N2 NSCLC requires multi-modality treatment: local treatment (surgery or radiotherapy) and systemic anti-cancer therapy. There is no clear evidence of superiority for survival between surgical and non-surgical approaches and little research has explored quality of life as an endpoint (QOL). Methods: Randomised controlled feasibility study. Patients are randomised to receive multi-modality treatment 1) with surgery OR 2) without surgery. Eligible patients have ‘potentially resectable’ N2 NSCLC and have received an MDT recommendation for multimodality treatment. Sixty-six patients and their carers will be recruited from 8 UK centres. Patient/carer QOL questionnaires will be administered at baseline, weeks 6, 9, 12 and month 6, data will be analysed descriptively. Semi-structured interviews will be conducted and framework analysis applied. Results: Recruitment is ongoing (opened November 2020). Despite COVID-19 related challenges, we have opened six sites, approached 14 patients and successfully recruited nine patients (64% consent rate) and five carers. Four patients and two carers have completed the trial. Five patients (55%) have completed all outcome data to date and eight patients (89%) have received their allocated treatment. NSCLC N2 patients being assessed at MDTs at recruiting sites are being assessed for eligibility. Forty-seven N2 patients have been identified as ineligible. Reasons for ineligibility include: not suitable for surgery;referred for best supportive care;MDT decision regarding most appropriate treatment;patient choice regarding treatment;other. Conclusion: There have been challenges to site opening due to sites focusing on COVID related studies only. Three sites have only opened in the past 6 months and a further two are due to open which should increase recruitment. Despite delays we have successfully recruited nine participants and all but one have received their allocated treatment. Results will inform the design of a future fully powered randomised trial with QOL as the primary outcome.
ABSTRACT
P111 Figure 1Monthly percentage change in referrals during pandemic from pre-pandemic year. National trend in COVID-19 cases in background for comparison[Figure omitted. See PDF]ConclusionsThe data shows the impact of the pandemic on our tertiary service with an increase in referrals over the year following the first lockdown. More patients required emergency inpatient transfers and a higher proportion required airway stents reflecting more advanced and symptomatic disease. Unsurprisingly, the busiest months followed the national peaks of COVID-19 cases. The public health messaging required to control the pandemic, although necessary, coupled with an overlap of symptoms has resulted in an increase in presentations of life-threatening MCAO. This highlights the importance of early detection of lung cancer and recognition of symptoms of central airway obstruction.