Lung cancer

Experts call for national lung cancer Clinical Quality Registry to address inequalities


Australia needs a national lung cancer Clinical Quality Registry to address widespread inequality in access to services and unwarranted variations in treatments and outcomes, experts say.

Systematic change is needed to address numerous ongoing deficits and discrepancies in lung cancer care in Australia, such as the low levels of staging at diagnosis, according to a commentary article by oncologists and respiratory physicians published in Respirology.

The authors, led by Dr Fraser Brins of Curtin University, Perth, say inequality and inequity is apparent across Australasia in the risk of lung cancer, access to services, optimal treatments and outcomes. Wide variations are seen based on socio-economic status, regional versus city location, public versus private facilities and within indigenous and culturally diverse populations in Australia.

However, without an integrated national system of data collection on variations in care, it will be difficult to take any action to improve quality to meet benchmarks, they warn.

“Multiple sources of data consistently demonstrate the same messages. There is an unmet need to identify and alleviate unwarranted variation in lung cancer management process and outcomes across Australasia. Clinical Quality Registries (CQRs) are likely the best means to achieve this,” they write.

A data-based strategy to identify and reduce variation in health care would have to be systematic and have the infrastructure to identify, interpret and respond to unwarranted variation, they suggest.

“Such a self-improving system requires the accurate collection of diagnostic, treatment and linked outcome data; the capacity to risk-adjust and analyse these data; and provide feedback to providers. Such a system must be able to adapt to advances in therapeutics and diagnostics and have clear benchmarks against clinical key performance indicators that can influence change with targeted reports.”

The authors suggest that Australia could develop a lung cancer CQR based on the UK model of a National Lung Cancer Audit (NLCA) that is now set up and using data to drive improvements in the quality of lung cancer care.

“Publicly available reports demonstrate improvements in different domains of care such as histological confirmation rates, proportion receiving SACT, surgical resection rates and even correlating quality of lung cancer services with 1-year survival rates,” they note.

A similar Australian system would capture data from the time of diagnosis and add it to a centralszed database. It would use quality indicators of care that are evidence based, easy to collect, adaptable, measurable and comparable, with a strong focus on timeliness of care and patient-reported outcome measures.

“A CQR capable of data linkage with prescribing, healthcare utilization and hospital admissions data would ensure a comprehensive capture of health service utilization. This will provide invaluable insights into health behaviours leading up to the diagnosis, real-life data on health service utilization during treatment and provide vital downstream evidence of the impact of screening programs,” the authors say.

“The creation of national lung cancer CQRs … is a significant challenge but one that, if successful, will highlight best practices, identify and reduce variation in practice, demonstrate where improvement is needed, guide investment in lung cancer resources and provide a rich source for research,” they conclude.

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