the 24 bulletin
Thoracic Audit Update: where next for LCCOP? Doug West, Audit Subcommittee Chair
W
ith a separate article in this Bulletin dedicated to the Society’s proposals for reforming adult cardiac audit, I’ve taken the opportunity to focus this article on the significant changes to the NHS England Lung Cancer Clinical Outcomes Project (LCCOP) project this year. LCCOP began in 2014 and has provided an annual report every year since. Produced by the National Lung Cancer Audit working with the Society, it was the first compulsory audit of lung cancer surgery in England. Over time it has developed, incorporating risk adjustment, longer term outcomes and new metrics such as unit – level resection rates and readmissions in later reports. The Society has supported LCCOP as a means to reassure patients about the quality of care, and to help units reflect on and improve their service. There is more that should be done to develop it, but the universal reporting of results for every patient and every NHS unit was a milestone for lung cancer surgery. LCCOP is delivered by the NLCA as part of its wider contract with HQIP. Last year, the NLCA was re-commissioned. The
invitation to tender for the new contract was released later than expected. When it was released, the terms proposed by HQIP led the NLCA team to decide not to submit a bid. No other acceptable bids were received, and several months of negotiation between NLCA (who are hosted by the London College of Physicians) and HQIP ensued. In the last few weeks, a 15 month contract has at last been agreed between HQIP and NLCA. This agreement will deliver a pared-down version of the lung cancer audit, and with it LCCOP. Although it is welcome that LCCOP will be delivered in some form, we are concerned that there is no intention to produce a formal report; the contract agreement is only to produce data tables. The SCTS have voiced concern, believing that a report of some kind is essential both to interpret the raw data and to set it in a clinical context. We also think that a dissemination plan is vital if LCCOP is to continue to have impact. We have seen huge improvements in our specialty during the period of the LCCOP project. VATS has displaced open surgery as the commonest approach to lung resection, hospital stay has fallen significantly, and
“We have seen huge improvements in our specialty during the period of the LCCOP project. VATS has displaced open surgery as the commonest approach to lung resection, hospital stay has fallen significantly, and far more patients now receive potentially curative surgery.”
far more patients now receive potentially curative surgery, with an increase of over 1000 operations/year in just the last three years. We must not let the focus of government and other stakeholders be diverted at this vital time, when despite our efforts, resection rates continue to lag equivalent European and other nations. The Society is exploring how we could support a report and dissemination plan this year, while a longer term solution is worked upon. We are also engaging with the Roy Castle Foundation to obtain patient feedback on the audit, and to make sure that any future project meets patient needs. We should have a better idea of what is possible in the next few months. These events mean that this year’s validation round will be later than in previous years, and is now expected between mid-September and midOctober 2020. As always, your oversight of the data is an essential part of improving its quality, so please do validate your unit’s data in good time. The results are expected in the first quarter of 2021. We anticipate largely the same outcomes as reported last year (30 and 365 day adjusted survival, median length of stay, 90 day readmission), but following the reporting of the VIOLET trial last year we are trying to have VATS rates in earlystage disease included as a new metric. While the organisational structures of national thoracic audit may be changing, the Society continues to advocate for universal and transparent reporting, team-based assessment and support for clinical teams to reflect upon and improve their practice. We can’t return to an era when outcomes were unknown to patients, and to the clinicians charged with their care. Thank you all for the contributions you make to thoracic audit. n