Increasing the surgical resection rate for lung cancer in the UK: the debate

Abstract

SUMMARY The UK has historically had poorer survival statistics for lung cancer and, indeed, most other cancers than major comparator countries. While there have been modest improvements in survival for lung cancer patients internationally in recent years, the gap between the UK and a number of other western countries has not narrowed. In parallel with this, the surgical resection rate for lung cancer patients in the UK has historically been very much lower than those reported from many other countries. Since surgery is the treatment that is most likely to result in long-term survival, it seems likely that the two findings are related. It is also clear that resection rates vary widely across the UK, that there is a positive correlation between resection rate and survival and that when specialist thoracic surgeons are employed in lung cancer multidisciplinary teams, resection rates rise quickly and dramatically. Effective auditing of the standards of care through the National Lung Cancer Audit project has identified problems at a national and local level and, with support from professional bodies, the UK has nearly doubled the number of specialist thoracic surgeons since 2005. A dramatic increase in resection rates followed, from approximately 3000 per annum in 2005 to 5000 per annum in 2010. There are parallels with a wide range of nonsurgical interventions in lung and other cancers, pointing to the fact that efforts need to be made to ensure that all patients have access to the optimum care from an expert multidisciplinary clinical team at all stages of their care.