Introduction and overview
This quality standard covers the diagnosis and management of lung cancer in adults (18 years and over), and the supportive care provided to people with lung cancer. For more information see the scope for this quality standard.
There are more than 40,000 new cases of lung cancer in the UK each year and more than 35,000 people die from the condition; more than for breast cancer and colorectal cancer combined. It is the second commonest cancer in men and women, and the leading cause of cancer death in men and women.
About 90% of lung cancers are caused by smoking. Now that fewer men smoke, lung cancer deaths in men have decreased by more than a quarter in the UK (a 27% reduction between 1971 and 2006). However, the number of women who smoke has risen and deaths from lung cancer in women have increased. The incidence of lung cancer in England and Wales is believed to be 47.4 per 100,000 population, and is strongly associated with deprivation; the rate is almost 2.5 times higher in most deprived male groups compared with the least deprived and 3 times greater among women.
The prognosis for lung cancer is poor, with a mortality rate of 40.1/100,000 population and only 1 in 10 people living for more than 5 years after diagnosis. The prevalence reflects this poor prognosis with an estimate of 65,000 individuals living with lung cancer in 2008. Only about 5.5% of lung cancers are currently cured. Although the cure rate is rising slowly, the rate of improvement has been slower than for other common cancers, and outcomes in the UK are worse than those in some European countries and North America. There is evidence that outcomes vary within the UK, which ‑ among other factors ‑ may be explained by variations in the standard of care.
Lung cancer has one of the lowest survival outcomes of any cancer because over two-thirds of patients are diagnosed at a late stage when curative treatment is not possible. Earlier diagnosis and referral to specialist teams would make a significant difference to survival rates. Many of the patients are elderly with co-existing comorbid problems making them unfit for radical treatment but new surgical techniques may enable more patients with complex medical problems to benefit from surgery.
This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with lung cancer in the following ways:
Preventing people from dying prematurely.
Enhancing quality of life for people with long-term conditions.
Helping people to recover from episodes of ill health or following injury.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
The NHS Outcomes Framework 2011/12 is available from www.dh.gov.uk
The quality standard for lung cancer requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole lung cancer care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with lung cancer.