Cross-pathway efforts are needed to optimise multi-modality treatment for non-small cell lung cancer

About 49,200 patients are diagnosed with lung cancer every year in the UK.¹ While lung cancer is the third most common cancer, it is the most common cause of cancer death, with about 34,800 deaths annually.¹ The most common lung cancer is non-small cell lung cancer, which can affect non-smokers as well as smokers.²

The treatment paradigm in lung cancer is changing rapidly due to recent advances and newly emerging therapeutic options. Stage II/III NSCLC has particularly benefited from the advent of curative-intent multi-modality treatment, in which local and systemic therapies are combined. However, as new therapies and treatment approaches continue to emerge, the complexity of decision-making increases, putting additional pressure on clinicians already battling to achieve National Optimal Lung Cancer Pathway targets of 49 days from referral to treatment and 16 days from decision to treat to treatment.³

Wilmington Healthcare recently ran a roundtable event to discuss optimal delivery of curative-intent multi-modality treatment for patients with NSCLC, initiated and funded by Bristol Myers Squibb. A group of experts at this meeting agreed on the increasing complexities of lung cancer treatment through their own experiences in the field and that the expertise of all specialties is required to deliver a holistic package of care to optimise patient outcomes.

The panellists identified barriers to achieving high-quality service delivery, standardised care, and good patient experiences, as well as unwarranted variation, which is a significant focus for the NHS. The group highlighted that work is needed around diagnosis and staging, biomarker testing, patient selection, and decision-making and discussed solutions already in place within the NHS.

For diagnosis and staging, key ambitions are to ensure adequate capacity for demand and quality assurance of the diagnostic pathway. Direct telephone booking systems are allowing clinicians to directly contact diagnostic and staging services to arrange appointments (e.g. imaging) while patients are still in clinic to confirm whether times and dates are convenient to them. Use of patient navigators has ensured effective patient tracking through oversight of tests and results in the system.

Biomarker results are critically important for treatment decisions and ensure best practice in terms of appropriate patient selection for different treatment regimens, with a personalised treatment approach now both feasible and essential. Rapid testing pathways are needed so that timely multidisciplinary team discussions and consultations can be facilitated with results on hand for specialists to use when discussing treatment options.

Key areas for investment to support this include improvements in local testing availability and protocols, enhancement and integration of communication, and resource allocation between pathology and genomic services, which will all improve efficiency of biomarker testing; installation of up-to-date information technology and software across departments and organisations; and universal access to reports for all stakeholders.

Innovative approaches to clinics and multidisciplinary teams (MDTs) are also needed. Joint oncology and surgical clinics can optimise treatment and reduce adverse events, with different models available to fit with local organisational structures. For example, in Manchester, a One Stop Clinic with a multidisciplinary team of the full range of healthcare professionals involved in lung cancer care supports patients in informed treatment decision-making and has reduced time from referral to decision to treat and surgical length of stay. Decision-support and artificial intelligence tools available on mobile phones can facilitate efficient working practices and should be trialled and tested.

Access to a clinical nurse specialist for all patients is crucial. These highly skilled healthcare professionals have a key role in enhancing the patient experience by ensuring equity of access, offering support to help patients understand treatment options and make decisions, and reinforcing the importance of prehabilitation and rehabilitation to ensure patients are as fit as possible before and after treatment. The patient experience can also be enhanced by better communication with patients about pathways structures at all steps of their patient journey, high-quality printed patient information, and referral to sources of support.

The NHS is at a once-in-a-lifetime turning point in terms of the management of stage II/III NSCLC, and it must recognise where it is not performing well and the urgent need to improve. Implementation of the recommendations of this expert group will lead to more efficient, effective, and patient-centred care, and the NHS must seize this opportunity if patients with NSCLC are to reap the benefits of the new treatment modalities.

A white paper was produced from the roundtable event detailing its conclusions, which is available here. Clicking this link will take you to an external website hosted by Bristol Myers Squibb.

References

1. Cancer Research UK. Lung cancer statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer (accessed June 2024).

2. Macmillan Cancer Support. Non-small cell lung cancer (NSCLC). Available at: https://www.macmillan.org.uk/cancer-information-and-support/lung-cancer/non-small-cell-lung-cancer (accessed June 2024).

3. NHS England. National Optimal Lung Cancer Pathway (NOLCP) for suspected and confirmed lung cancer: referral to treatment. Update 2024, Version 4.0. https://roycastle.org/app/uploads/2024/03/National-Optimal-Lung-Cancer-Pathway-V4-01Jan2024.pptx (accessed June 2024).