Lack of access to specialists is a major factor in the UK’s high lung cancer mortality rates, according to the UK Lung Cancer Coalition.

The coalition, which includes doctors, pharmaceutical companies and patient groups, has produced an “aspirational” guide to delivering lung cancer care.

Late diagnosis, poorly structured care teams and a “nihilistic view” of the patient’s prognosis were also identified as reducing patient survival rates.

The coalition’s Dream MDT report makes 30 recommendations for delivering lung cancer diagnosis, treatment and care through multidisciplinary teams (MDTs).

The report says these recommendations “should challenge lung cancer practice to strive to exceed, rather than simply meet, NICE guidelines”.

The UK has 240 lung cancer MDTs but too few specialists and a culture of low expectation, the coalition argues. Its recommendations include:

• A Lung Cancer Nurse Specialist should play a key role in ensuring optimal care for each patient.

• Transfer of care from secondary to primary care needs to be improved, with the GP informed of the patient’s progress at all stages.

• Each patient should be assigned a specialist lung cancer physician to manage their treatment.

• The MDT should deliver a two-stage process: diagnosis and treatment.

• Patients should know at all times what the next step is in their care pathway.

According to the coalition, about a third of NHS lung cancer patients do not have access to lung cancer specialist nurses or physicians.

By following the recommendations, the NHS could save 10% of the lives currently being lost to lung cancer, the coalition argued.

While smoking cessation programmes have reduced the incidence of lung cancer, prognosis for those diagnosed with the condition is usually poor.

The NHS Outcomes Framework 2013/14 has abandoned the draft document’s aim of setting ‘levels of ambition’ in relation to the outcomes.

The decision to avoid setting specific targets mirrors the NHS Mandate, which requires the NHS Commissioning Board to aim for “measureable improvement” across a range of objectives.

Like the final NHS Mandate, the new Outcomes Framework contains new objectives for improving the treatment of dementia and mental illness.

The key changes to the NHS Outcomes Framework include:

• The overarching indicator for reducing potential years of life lost includes a new measure referring to “children and young people”.

• The indicators for cancer survival are widened to include “all cancers”, in order to ensure that rarer cancers are not overlooked, as well as “all cancers in children”.

• To strengthen the focus on dementia care, there are new indicators for the diagnosis rate and the effectiveness of care in “sustaining independence and improving quality of life”.

• The indicators for mental health care include a new measure promoting access to psychological therapies for people suffering from depression and anxiety.

• A new ‘placeholder’ indicator focuses on improving “people’s experience of integrated care”.

The NHS Outcomes Framework sets the clinical objectives for CCGs to follow in commissioning services that meet these objectives as well as the financial targets set by the NHS CB.

The 2013/14 Outcomes Framework, for the first time, will appear alongside new outcomes frameworks for public health and social care services.

Poole Hospital in Dorset has been rated the country’s leading NHS provider of cancer care by patients.

In the 2011/12 National Cancer Patient Experience Survey, 94% of the hospital’s cancer patients rated their care as ‘excellent’ or ‘very good’.

The responses to over half of the 70 questions asked about care at Poole Hospital were in the highest-scoring 20% of all NHS trusts.

Areas where the Dorset hospital was rated particularly highly included: access to and support from cancer nurse specialists; consultations by hospital doctors; support from nurses; and quality of information given at discharge.

The hospital’s cancer services also gained high ratings for the dignity, privacy and sensitivity of its communication and treatment.

“We are committed to ensuring the highest standards of care for patients in the Dorset Cancer Centre at Poole, and are delighted to see that the hard work and dedication of our staff has been recognised in this survey,” said Poole Hospital’s Clinical Director for Cancer Services, Dr Mike Bayne.

The survey was carried out in January 2012, and covered patients treated from September to November 2011.

Cancer patients in the north of England believe they receive a better experience of care than individuals with the disease in London, a new survey has revealed.

A survey by MacMillan Cancer Support found that nine out of the bottom ten trusts for patient experience were based in the capital; whereas eight out of the top ten performing trusts were located in the north of England.

Harrogate and District NHS Foundation Trust was voted the best performing trust for the second year running with Imperial College Healthcare NHS Trust in London again performing the poorest.

Ciarán Devane (pictured), Chief Executive of Macmillan Cancer Support, said that although hospitals had raised standards “far too many cancer patients are being let down by hospitals failing to provide an adequate level of care.”

The Chief Executive has now called for struggling trusts to “take heed” of the findings and work with the charity to improve the standards of care they offer to patients. “Imperial, while still at the bottom of the table, is committed to addressing the problem and working well with Macmillan and cancer patients,” he said. “But these things take time, and won’t happen if they do not have sustained, top-level commitment.”

In the survey Imperial was criticised on the amount of time outpatients waited to be seen and on the access patients had to a clinical nurse specialist. However, respondents did state that their first appointment with a hospital doctor was sooner than expected.

A spokesperson for the Trust acknowledged that the “experience of some of our cancer patients was below the standard we strive to deliver”.

“We are fully committed to working with Macmillan Cancer Support, as well as other cancer charities and patient groups, and are doing our very best to improve the experience of our cancer patients. We are also continuing to strengthen our relationships with GPs and community services.

“We have listened to patient feedback and have implemented a number of improvement programmes.”

Meanwhile, Harrogate was praised for giving patients easy to understand written information about test results and how ward nurses answered nearly all the questions patients asked.

Research also found that patients with breast cancer felt they were given the best experience of care with those with sarcoma believing they had the poorest experience.

Top 10 performing trusts

*ranked on the number of times they appear in the top 20% of Trusts, further ranked by the number of times they appear in the bottom 20% of Trusts.

Bottom 10 performing trusts

**ranked on the number of times they appear in the bottom 20% of Trusts, further ranked by the number of times they appear in the top 20% of Trusts.

The last year has seen patient experience of cancer treatment improve, according to a national survey.

Overall 88% of patients rated their care as excellent or very good, and 98 trusts have improved on their scores from last year.

Approval of the speed, choice and privacy of treatment all showed slight improvement relative to the first survey in 2011.

Reports have been sent to individual trusts on feedback from patients in their care, enabling them to focus on weaknesses.

The survey, carried out by Quality Health, also found that 95% of cancer patients were keen to participate in cancer research.

Over 70,000 patients were surveyed. Relative to 2010, approval increased for speed of treatment (83% from 81%), choice of treatment (84% from 83%) and privacy of treatment (94% from 93%).

The 10 most improved foundation trusts in the survey were: Portsmouth Hospitals, Guy’s & St Thomas’, Tameside Hospital, The Royal Marsden, Western Sussex Hospitals, East Kent University Hospitals, University Hospital Bristol, South Tyneside, Norfolk & Norwich University Hospitals and Medway.

“The information from this survey is vital to driving improvements on the ground for patients,” said National Cancer Director Professor Sir Mike Richards (pictured). “By seeing what areas they can improve upon, the local NHS can focus on the areas that matter most to patients.”

Macmillan Cancer Support and the Royal College of Nursing (RCN) welcomed these findings, but emphasised the need for rarer cancers to be treated as effectively as more common types.

Dr Peter Carter, RCN Chief Executive, noted that the survey “recognises the important contribution that specialist nurses make to patients with cancer”

CCGs may go the way of GP fundholding, according to senior NHS manager Sir Robert Naylor.

The Chief Executive of UCLH said the new structure would create “a vacuum of strategic leadership and direction”, making further reform necessary.

He also claimed that “rationalisation” of services was already being arranged between providers “behind the scenes”.

Speaking at the King’s Fund, Naylor said: “The jury is still very much out on whether the latest commissioning arrangements will last any longer than fundholding did.”

Whoever won the next general election, he said, it was inevitable that another NHS reorganisation would be needed to provide “strategic leadership”.

In the absence of SHAs, Naylor argued, the CCGs would not be “cohesive enough” to determine healthcare priorities in major cities.

He was sceptical of the ability of the NHS Commissioning Board to provide the necessary “strategic leadership”.

Speaking at the Commissioning Show in the same week, Naylor said: “My main fear is that GP commissioning will lead to ever-increasing fragmentation.”

His experience of London-based commissioners indicated that their concern was with day to day service issues, and they were unable to make strategic decisions on issues such as “the future of cancer care”.

Those decisions were being made “behind the scenes in discussions between providers”, he said.

An example was the way UCLH had “swapped” services with the Royal Free Foundation Trust, with one taking on neurosurgery and the other liver surgery.

The FDA has approved Abbott Molecular’s Vysis ALK Break Apart FISH Probe companion diagnostic for lung cancer patients.

The test detects all ALK gene rearrangements and is the only FDA-approved diagnostic assay to predict response using Pfizer’s targeted therapy Xalkori for patients with advanced ALK-positive non-small cell lung cancer (NSCLC).

Dr Mark Brecher, Chief Medical Officer of LabCorp, said that the personalised medication “will play an even larger role in cancer care, assisting physicians in administering the treatments best suited to the disease.”

The Probe Kit for Xalkori uses Fluorescence In-Situ Hybridisation (FISH) to detect a specific rearrangement in the ALK gene.

Approximately 3-5% of NSCLC tumours are characterised by genetic rearrangements in the ALK gene. When this gene is altered by combining ALK with other gene sequences, the pathway becomes constitutively active causing mutation. Xalkori inhibits the mutant ALK protein, and halts the growth of cancer cells.

LabCorp’s Centre for Molecular Biology and Pathology (CMBP) supported clinical studies of the new diagnostic and collaborated with Abbott Molecular in the analytical validation of the product.

According to LabCorp, approximately 6,500-11,000 people will develop advanced ALK-positive NSCLC in the US in 2011.

The Vysis ALK Break Apart FISH Probe test is available for patient testing through LabCorp, which is one of the largest medical diagnostic companies in the US.