1. Segmented analysis of the lung cancer median pathway from referral to treatment: 2013-2015
This work was carried out in partnership between the Transforming Cancer Services Team for London (TCST) and PHE’s National Cancer Registry and Analysis Service (NCRAS)

2. Overview

3. Overview
Aim
To assess the typical pathway for lung cancer in London in the aim to understand the pathway better as this is a pathway that is challenged in terms of meeting the 62 day standard.
Objectives
To measure the typical time taken in the different stages of the lung cancer pathway
To assess the typical pathway for London segmented by various demographics
Method
Confirmed lung cancer cases resident in London and West Essex diagnosed were selected as the cohort population. This includes all referral routes.
Cancer registry data, including data recorded on the National Cancer Waits Database (CWT), Hospital Episodes Statistics (HES), and trust submitted pathology reports and MDT dates, was used in this analysis.
The absolute median time taken between the different intervals in the pathway were calculated segmented by various demographics.
Cases identified through death certificate only were not included in this analysis.

4. Overview
Pathway is presented by the median time taken between the following:
Referral date
First seen in secondary care date
Diagnosis date
MDT date
Treatment start date
Pathway is segmented by the following demographics:
Year of diagnosis ( )
Sex
Stage at diagnosis
Age at diagnosis
Income domain quintile
Ethnicity
Resident CCG
Diagnosis trust

5. Variable Data Completeness by Year (London)
Sources used
2013
2014
2015
Tumour count
(N)
Completeness (%)
Total tumours
PHE’s national cancer registration data
4,228
100.00
4,172
Death Certificate Only
154
3.64 95
2.25 55
1.32
Referral date
Cancer Waiting Times database
2,039
48.25
2,001
47.33
2,088
50.05
First seen date
1,957
46.29
1,938
45.84
2,092
50.14
Diagnosis date
Derived from PHE’s national cancer registration data*
MDT date
Cancer Waiting Times database, Cancer Care Plan database
2,764
65.37
2,957
69.94
2,988
71.62
Treatment start date
2,872
67.93
2,803
66.30
2,910
69.75
*The cancer registry derive the diagnosis date from the following events in order of prioritisation: first histological/cytological confirmation of the malignancy, the first admission to hospital because of the malignancy, and when a patient is evaluated in out patient clinic.

6. Results: Summary
FOR INTERNAL DISTRIBUTION ONLY

7. England and London Lung Tumour Counts (2013-2015)

8. Lung Cancer Pathway from Referral to Treatment for England and London (2013-2015)

9. Lung Cancer Pathway from Referral to Treatment for England and London by Sex (2013-2015)

10. Colorectal, Lung and Prostate Pathways from Referral to Treatment for England and London (2015)

11. Results: Stage at Diagnosis

12. Distribution of Stage at Diagnosis for Lung Cancer, England and London (2013-2015)

13. Lung Tumour Counts by Stage at Diagnosis, London (2013-2015)

14. Lung Cancer Pathway from Referral to Treatment by Stage at Diagnosis, London and England (2015)

15. Results: Age at Diagnosis

16. Distribution of Age at Diagnosis for Lung Cancer, England and London (2013-2015)
Axis to 0dp
Change title to be consistent language with other distribution slides
UPDATE TO 40+

17. Lung Tumour Counts by Age at Diagnosis, London (2013-2015)

18. Lung Cancer Pathway from Referral to Treatment by Age at Diagnosis, England and London (2015)

19. Results: Ethnicity

20. Distribution of Ethnicity for Lung Cancer Patients, England and London (2013-2015)

21. Lung Tumour Counts by Ethnicity at Diagnosis, London (2013-2015)

22. Lung Cancer Pathway from Referral to Treatment by Ethnicity, England and London (2015)

23. Results: Income Domain Deprivation Quintile

24. Distribution of Income Domain Quintile for Lung Cancer, England and London (2013-2015)

25. Lung Cancer Patient Counts by Income Domain Quintile, London (2015)

26. Lung Cancer Pathway from Referral to Treatment by income domain quintile, England and London (2015)

27. Results: Resident CCG

28. Lung Tumour Counts by Resident CCG and STP, London (2015)

29. Pathway by Resident CCG and STP, London (2015)

30. Pathway by CCG and year of diagnosis (North Central London)

31. Pathway by CCG and year of diagnosis (North East London)

32. Pathway by CCG and year of diagnosis (North West London)

33. Pathway by CCG and year of diagnosis (South East London)

34. Pathway by CCG and year of diagnosis (South West London)

35. Pathway by CCG and year of diagnosis (West Essex)

36. Results: Diagnosis Trust

37. Pathway by Diagnosis Trust and STP, London (2015)

38. Pathway by Diagnosis Trust and Year of Diagnosis (North Central London)

39. Pathway by Diagnosis Trust and Year of Diagnosis (North East London)

40. Pathway by Diagnosis Trust and Year of Diagnosis (North West London)

41. Pathway by Diagnosis Trust and Year of Diagnosis (South East London)

42. Pathway by Diagnosis Trust and Year of Diagnosis (South West London)

43. Pathway by Diagnosis Trust and Year of Diagnosis (West Essex)

44. Summary
It was found that lung cancer had the shortest pathway for England and London when compared to pathways for colorectal and prostate pathways for the same regions.
Although median pathway time remains consistent in London, there are variations at a CCG level.
For lung cancer, stage 1 has the longest pathway, and stage 4 has the shortest pathway for England and London.
For lung cancer, shorter pathways are associated with older people. For both England and London those 90 years or older had the shortest pathway.
For lung cancer, the pathway length was found to be consistent for all income domain quintiles for both England and London.
In 2015, those of Asian ethnicity were found to have the longest pathways for colorectal cancer in England and London.
In 2015, there is a wide variation in pathway length by resident CCG for lung cancer. Hillingdon was found to have the shortest pathway, whilst Harrow has the longest pathway.
For lung cancer, there is wide variation in pathway length when reviewed by diagnosis trust.
To finish