Defrauding UK lung cancer patients.

The figures for survival rates from lung cancer are poor throughout the world. The only real hope of a cure is surgery, and that is rarely possible. Palliative treatment, such as a radiotherapy and chemotherapy, is however valuable for prolonging remission and improving quality of life.

The statistics for lung cancer survival are particularly poor in the UK when compared with many parts of Europe and the USA. Figures vary slightly depending on source, but the overall message is clear. Best not to have lung cancer in the UK.

Lung cancer - one and five year survival rates
Lung cancer has one of the lowest survival outcomes of any cancer. In England and Wales around 25% of patients are alive one year after diagnosis and this falls to 7% at five years

International comparisons of lung cancer survival show large differences.

Five-year relative survival estimates for the USA are 13% for men and 17% for women.

The highest five-year survival rates for lung cancer in Europe are in Austria, France, Germany, The Netherlands and Spain at around 11-13% for men and 11-16% for women. (source 1)

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5-year survival rate for men aged 15-99 with lung cancer is 5.2% in England and Wales 1991-95 (Cancer Survival, National Statistics)

5-year survival rate for people with lung and bronchus cancer is 13.4% in the US 1983-90 (SEER) (source 2)

In simple terms, get lung cancer in the USA or Europe and you have twice the chance of living five years than you have if you get it in the UK.

Why should this be? It was, after all, research done in England by Sir Richard Doll which first demonstrated that smoking was the cause of lung cancer. Having found the cause, why are we not taking a lead in the treatment of lung cancer?

Once again, it is a resource issue.

Surgery offers the best chance of a cure. The earlier the diagnosis, the greater the chances of surgery. Early diagnosis needs a quick turn round of chest X-Rays, both in hospital and in the community. For that we need more diagnostic radiologists and more radiographers. Where Dr Crippen works, it is often taking two weeks to get a chest X-Ray reported.

We need more PET Scanners. A PET scan will tell you if a tumour is operable. There are more PET scanners in New York than there are in the United Kingdom.

We need more radiation oncologists. The treatment of lung cancer usually means either radiotherapy or chemotherapy or both. Dr Crippen has had lung cancer patients die before they get to the radiotherapist.

And not just more radiation oncologists; we need the existing ones to take an interest in lung cancer. They need to start using the drugs that are in routine and wide use both in the USA and in Europe. Trouble is, though lung cancer is common, it does not have the glamour of breast cancer. It does not attract much oncological interest.

Chest physicians are notoriously nihilistic about lung cancer. “Oh the prognosis is awful what ever you do” and so, quite often, they do nothing. They call it “watch and wait”. Some do not even bother to follow up the patients personally. They hand them over to the nurses.

BMJ : management of lung cancer

The main areas of concern are the use of chemotherapy for the palliative treatment of non-small cell lung cancer and the use of combined chemotherapy and radiotherapy for locally advanced non-small cell lung cancer and small cell lung cancer in suitable patients, as pointed out by European colleagues.2 We believe that the current guidelines confuse the issues and may well serve to maintain the nihilism surrounding lung cancer in the United Kingdom. This nihilism still means that:

• Many patients with lung cancer never see an oncologist
• Many patients' disease is not staged by computed tomography
• Oncologists with training in and enthusiasm for lung cancer are in short supply
• Combined modality treatments (radical radiotherapy and chemotherapy) are not routinely used where appropriate for both non-small cell lung cancer and small cell lung cancer
• Suitable patients are not offered chemotherapy for palliation
• Purchasers can now use these guidelines to deny funding for patients with lung cancer;
• Unlike those working elsewhere in Europe and North America, we in the United Kingdom cannot move the subject forward or contribute to the development of new drug regimens.

The five year survival figures for lung cancer in England and Scotland (6-7%) are lower than those in our nearest European countries (France 14%). The treatment of lung cancer in the United Kingdom is patchy, with chest physicians the gatekeepers. (BMJ)

A controversial area maybe but there is evidence that active and aggressive treatment of lung cancer improves survival rate:

This study has shown wide variations in the rates of active treatment for lung cancer patients within districts across one large region of England. Active treatment was strongly associated with improved survival, especially in non-small cell lung cancer.

How has the government reacted to this shameful situation in the UK?

It has reacted as it usually reacts to lack of health care. It has appointed some nurse-specialists to paper over the cracks.

Take a look at Integrating Lung Cancer Nursing : A good practice guide. It is all the usual stuff; pathways and protocols, journeys and voyages

There will undoubtedly be howls of anguish from all the usual sources if Dr Crippen says this document restates the obvious, adds nothing and is full of flowery, meaningless codswallop. But that is the truth of the matter. There are plenty more documents like this. The government health care spin machine is in full flow. Put lung cancer nurse specialists into Google. This is what you get.

Let us pick but one:

The Role of the Lung Cancer Nurse specialist. More patronising, meaningless guff.

The chest physicians find the lung cancer nurse specialists hugely helpful. They no longer have any experienced junior medial staff; certainly, no senior registrar. As they are nihilistic about the lung cancer patients, it helps to be able to pass them over to the nurses, whilst they get on with work they find more interesting and productive.

The lung cancer nurse specialist is a super secretary, general fixer, liaison officer, progress chaser and a sort of dumbed down SHO. Most of all, she is wonderful at hand-patting, which keeps the patients and their family happy.

NICE is very keen:

All cancer units/centres should have one or more trained lung cancer nurse specialists to see patients before and after diagnosis, to provide continuing support, and to facilitate communication between the secondary care team (including the MDT), the patient’s GP, the community team and the patient. Their role includes helping patients to access advice and support whenever they need it.

Now do not get Dr Crippen wrong. He is not suggesting for a moment that nurses do not have a valuable role to play in the treatment of patients with lung cancer. Of course they do. Then can, in particular, be wonderfully supportive to the patients who bounce around busy medical clinics at the hospital and do not always take in all the information that is thrown at them. We have seen the value of breast care nurses in the treatment of breast cancer.

The treatment of breast cancer is, however, properly funded, and the NHS breast cancer patient in the UK will get the optimum treatment. The services of the breast cancer nurse are a valuable bonus to the treatment but not a substitute for it.

Lung cancer treatment is under-resourced and largely ignored by the government.

We need more radiation oncologists with a genuine interest in lung cancer; we need funding for more trials on the optimum palliative chemotherapy for non-small cell lung cancer; we need more PET scanners and linear accelerators; we need more diagnostic radiologists.

Do not try to fool the general public into believing that progress chasing lung cancer nurse-specialists are going to transform the treatment of lung cancer in the country. They are not.

Yes, it is wonderful for the dying patient in the UK to have his hand patted by the NICE lung cancer nurse, but spare a moment to ask why his “voyage through his illness” is so much shorter than it would be in Europe or in the USA.

The government is not providing adequate funds. Only today it has been announced that NICE (a government organisation) has refused to authorise the introduction of drugs widely used to treat lung cancer in the USA and Europe.

We have the expertise. We have the drugs. And there are new and promising drugs in the pipeline.

An experimental lung cancer drug has extended patients' life expectancy by more than 50% in preliminary trials. Patients given the drug AS1404 on top of standard chemotherapy lived an average of 14 months compared with 8.8 months if given chemotherapy alone. (BBC)

What will happen if as and when this drug becomes available? Who knows, bu the government is not allowing doctors to use the drugs are ARE already available elsewhere. What is the point in all the nurse specialists if up-to-date treatment is not available?

The European lung cancer patient may not have a lung-cancer nurse to pat his hand, but he does have Tarceva to prolong his life. Which would you prefer?

The UK patient should have both.