Lung Cancer Patients with PS=3:

Lung Cancer CNG:Network audit of Lung Cancer patients with a Performance Status of 3Phil Owen Cancer Information Analystphil.owen@mccn.nhs.uk Confidential for management purposes only

Lung Cancer Patients with PS=3: • Fall on the boundary between fitness for active oncological treatments and “best supportive care”. • Some patients with PS=3 are deteriorating rapidly because of advanced cancer symptoms and have a very poor prognosis. • Others have stable chronic health problems that influence PS. • Others have an acute illness that may improve. Confidential for management purposes only

Histological diagnosis in patients with PS=3: • May not be attempted because the patient is felt to be deteriorating rapidly, be unfit for active treatment, and therefore unethical. • May not be possible if a patient has severe co-morbid health problems (severe COPD). Confidential for management purposes only

Histological Confirmation of Cancer: 2010 Lucada data: MCCN: 66.8% Target 75% Confidential for management purposes only

Aims of audit: • To determine the % of patients with lung cancer an PS=3 fall into each of the three subcategories. • To determine the % of patients who have histology/cytological diagnoses in those three categories. • To describe the different approaches to management and compare 12 month survival in the three different categories of patients with PS=3. • From this data to ask whether having a tissue diagnosis in lung cancer patients with PS=3 improves outcome. Confidential for management purposes only

Methodology: MCCN Trusts were asked in late 2011 to complete a questionnaire for 50 consecutive Lung Cancer patients with a Performance Score of 3. This was collated into a single spreadsheet and then compared with death data obtained from NWCIS on 21/03/12. Confidential for management purposes only

Assumptions/ Exclusions: • Basis of PS3: • 7 patients were recorded as having a PS3 based upon 1 and 4, but agreed that 1 outranks 4, so converted to 1. • UHA and WUTH completed an older version of the questionnaire, which did not include 4 as an option and accounts for 74 records. • What was the decision not to pursue tissue diagnosis based on?: • Some questionnaires had more than one response, but agreed to allocate the first reason from this ranked list (Patient Choice, Risk, PS, Unclear) • One year survival: • We were unable to verify one year survival/ death data for 8 patients for various reasons (3 had no valid NHS number, 1 had no date of diagnosis and 4 were diagnosed less than one year before the date that NWCIS were able to provide accurate data) Confidential for management purposes only

Confidential for management purposes only

Basis of PS3: 1 - Stable due to chronic illness 2 - Deteriorating due to advanced cancer symptoms (weight loss, fatigue) 3 - A combination of chronic illness and advanced cancer symptoms 4 - An acute potentially reversible illness (e.g. Fracture NOF, chest infection etc) Confidential for management purposes only

Route of presentation: 1 – IP presentation with symptoms & problems related to advanced cancer at presentation 2 – IP presentation with another illness: cancer detected incidentally 3 - Outpatient referral under two week rule 4 - Outpatient referral outside 2 week rule (5 – Other) Confidential for management purposes only

Route of presentation: 1 – IP with symptoms related to advanced cancer 2 – IP with another illness 3 – OP under 2 week rule 4 – OP outside 2 week rule 5 – Other Confidential for management purposes only

Basis of PS3: 1 - Stable due to chronic illness 2 - Deteriorating due to advanced cancer symptoms 3 - A combination of chronic illness & adv. cancer symptoms 4 - An acute potentially reversible illness Confidential for management purposes only

Route of presentation: 1 – IP presentation with symptoms & problems related to advanced cancer at presentation 2 – IP presentation with another illness: cancer detected incidentally 3 - Outpatient referral under two week rule 4 - Outpatient referral outside 2 week rule Confidential for management purposes only

For discussion: • Survival seems improved in patients with no histology but you could argue that numbers are too small to draw definitive conclusions • There is no explicit survival advantage in pursuing a tissue diagnosis in patients with PS=3 and this study does not support the notion that pursuit of histology in patients with PS 3 increases survival. • Is this because we are managing the patients actively, where appropriate and are not failing to treat patients radically simply because we don’t have tissue? Confidential for management purposes only

Any questions? Phil OwenCancer Information Analystphil.owen@mccn.nhs.uk 0151 201 4150 Confidential for management purposes only

Lung Cancer Patients with PS=3: