Lung Cancer in Adults: Quality Standard

Overview

This specialist Guidelines summary covers statements for the diagnosis and management of lung cancer in adults. It describes high-quality care in priority areas for improvement.

This summary is for use by oncology teams. For information on rationales and quality measures, refer to the original quality standard (QS17) from NICE.

List of Quality Statements

Quality Statement 1: Public Awareness

• Local authorities and healthcare commissioning groups use coordinated campaigns to raise awareness of the symptoms and signs of lung cancer and encourage people to seek medical advice if they need to.

Quality Statement 2: Stopping Smoking

• Adults with suspected or confirmed lung cancer who smoke receive evidence-based stop-smoking support.

Healthcare professionals (such as GPs, pharmacists, clinical nurse specialists, consultants and radiographers) provide advice to adults with suspected or confirmed lung cancer who smoke about why it is important to stop smoking. They arrange for them to access evidence-based stop-smoking support if they want to stop.

Quality Statement 3: Lung Cancer Clinical Nurse Specialist

• Adults with suspected or confirmed lung cancer have access to a named lung cancer clinical nurse specialist.

Healthcare professionals (such as members of the lung cancer multidisciplinary team) ensure that adults with suspected or confirmed lung cancer know how to contact a lung cancer clinical nurse specialist between hospital visits. Healthcare professionals share information with the lung cancer clinical nurse specialist to allow them to coordinate care for adults with lung cancer. Lung cancer clinical nurse specialists provide support and information to adults with lung cancer and carry out assessments at key points of care.

Quality Statement 4: Investigations

• Adults with lung cancer being considered for treatment with curative intent have investigations to accurately determine diagnosis and stage, and to assess lung function.

Healthcare professionals (such as consultants, clinical nurse specialists and consultant radiographers) arrange for adults with lung cancer who are being considered for treatment with curative intent to have investigations to accurately determine diagnosis and stage, and to check lung function. Healthcare professionals give people information about the purpose of the investigations, and discuss the results with them, including what they might mean for their treatment.

• Investigations should include:
  • Positron emission tomography (PET)-computed tomography (CT)
  • Stage-specific brain imaging for people with non-small-cell lung cancer
    • no brain imaging for people with stage I
      • contrast-enhanced brain CT for people with stage II
      • contrast-enhanced brain magnetic resonance imaging (MRI) for people with stage III
  • spirometry and transfer capacity for the uptake of carbon monoxide (TLCO) for people with non-small-cell lung cancer.

Quality Statement 5: Treatment with Curative Intent

• Adults with non-small-cell lung cancer stage I or II and good performance status have treatment with curative intent.

Healthcare professionals (such as members of lung cancer multidisciplinary teams) attend lung cancer multidisciplinary team meetings and advise on treatment options for adults with non-small-cell lung cancer. Healthcare professionals discuss the risks and benefits of treatment options with adults with stage I or II non-small-cell lung cancer and good performance status, and support them to make decisions about treatment.

Quality Statement 6: Tissue Sampling

• Adults with non-small-cell lung cancer stage III or IV who are having tissue sampling have samples taken that are suitable for pathological diagnosis and assessment of predictive biomarkers.

Healthcare professionals (such as respiratory specialists and radiologists) take tissue samples from adults with non-small-cell lung cancer stage III or IV that are suitable for pathological diagnosis and assessment of predictive biomarkers.

Providing there is no risk to the person, tissue samples of sufficient size and quality should be taken to support pathological diagnosis, including tumour sub-typing and assessment of predictive biomarkers. The samples should:

• allow pathologists to classify non-small-cell lung cancer into squamous cell carcinoma or adenocarcinoma wherever possible
• support stage-appropriate immunohistochemical and/or genetic analysis to detect specific biomarkers that predict whether targeted treatments are likely to be effective, for example, epidermal growth factor receptor mutations, anaplastic lymphoma kinase gene rearrangement, programmed death-ligand 1 (PD-L1) expression or ROS-1 gene mutation.

2012 Quality Standard

• Statements from the 2012 quality standard for lung cancer in adults that are still supported by the evidence may still be useful at a local level:
  • People with a chest X-ray result suggesting lung cancer and people aged 40 and over with unexplained haemoptysis are offered an appointment to see a cancer specialist within 2 weeks
  • People with lung cancer are offered a holistic needs assessment at each key stage of care that informs their care plan and the need for referral to specialist services
  • People with lung cancer, following initial assessment and CT scan, are offered investigations that give the most information about diagnosis and staging with the least risk of harm
  • People with lung cancer are offered assessment for multimodality treatment by a multidisciplinary team comprising all specialist core members
  • People with non-small-cell lung cancer stage I to III and good performance status who are unable to undergo surgery are assessed for radiotherapy with curative intent by a clinical oncologist specialising in thoracic oncology
  • People with lung cancer stage I to III who are offered radiotherapy with curative intent receive planned treatment techniques that optimise the dose to the tumour while minimising the risks of normal tissue damage
  • People with stage IIIB or IV non-small-cell lung cancer are offered systemic therapy in accordance with NICE guidance that is directed by histology, molecular markers and PD-L1 expression
  • People with small-cell lung cancer have treatment initiated within 2 weeks of the pathological diagnosis
  • People with lung cancer are offered a specialist follow-up appointment within 6 weeks of completing initial treatment and regular specialist follow-up thereafter, which can include protocol-led clinical nurse specialist follow-up
  • People with lung cancer have access to all appropriate palliative interventions delivered by expert clinicians and teams.