Lung Cancer Clinical Outcomes Project 2016 (2014 data)

 

What is the LCCOP?

The Lung Cancer Clinical Outcomes Publication or LCCOP is a mandatory audit of outcomes after surgery for lung cancer within the NHS in England.  It is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and the audit is delivered by the National Lung Cancer Audit team at the Royal College of Physicians of London.  It is part of HQIP’s Clinical Outcomes Publication (COP), a family of audits covering several surgical and some non-surgical clinical audits.   The SCTS is represented on the project board and clinical reference group.

The results are available as a downloadable PDF here, and in searchable form both at NHS Choices and here at SCTS.org.

 

Understanding resection rate reporting

Notes on Understanding Trust Resection Rate Reporting in the 2016 (2014 data) LCCOP Report, from the Society for Cardiothoracic Surgery are available here

 

What has changed from last year?

  • This is the second LCCOP report in 2016.  The first covered 2013 data.  By releasing two reports this year we are reducing the reporting time for the audit.
  • In this report, we have added data on median length of stay for individual units, and added national data on survival one year after surgery.
  • We have adjusted the survival outcomes this year to account for other factors within the data that may affect survival.  See the “notes on data adjustment” for more details.
  • Early in 2017 we will be adding in the resection rates for the cancer multidisciplinary teams (MDTs) which surgeons cover.

 

Which patients are included?

Patients who had an operation to remove a primary lung cancer within the English NHS during the calendar year 2014 are included.  Operations for diagnosis or symptom control are not included, or operations for other forms of chest cancer (for example, sarcomas, mesotheliomas and thymomas are not included).  Private patients are not included.  Currently LCCOP does not cover Wales, Scotland or Northern Ireland.

 

Where does the data come from?

The majority of the data comes from the Cancer Outcomes and Services Dataset (COSD) within NHS England.  This is data collected by local MDTs and submitted to cancer registries.  This year we have been able to link this data to the Hospital Episode Statistics, another NHS dataset.  Before the data is analysed, the names, operation dates and procedure types are returned to SCTS audit leads in individual units for validation.

 

Where is the data analysed?

The Respiratory Epidemiology Unit at the University of Nottingham is responsible for LCCOP data analysis.

 

What adjustment of the data has been performed?

Adjustment of data to allow comparison between surgical units is common in surgical audit.  To adjust data, patient characteristics which might affect their chances of a good outcome (for example their age, fitness or the severity of their disease) is analysed mathematically.  If a characteristic (for example, age) does affect outcome then the analysis can be “adjusted” to allow for this fact.  This means that a unit which operates on more high risk patients than others (for example, if they see an older or less fit population than other units) is not disadvantaged when the results are published.

Ideally, these adjustment models are developed from a large set of data, and then checked (or “validated”) on another set of data, to make sure that they can predict outcomes to some extent.

It is important to understand that the adjustment used in LCCOP this year has not been validated in this way.  All of the data has been used in the original model.  This means that, while this year’s adjustment has removed some of the variation in results due to case mix, we cannot use the mathematical models to predict outcomes for future patients.  The models have not yet been validated.

We also don’t know if we have adjusted for all of the differences that exist between the patients seen in different units, because we can only study the characteristic recorded in the databases we use.  There are characteristics that are probably important, but that we have not been able to correct for.

There is a validated risk adjustment tool in thoracic surgery, known as the Thoracoscore.  Unfortunately it uses several characteristics which are not currently recorded in HES or COSD.  This means that we cannot use it to risk adjust the LCCOP data.

Accepting that these limitations exist, the adjustment which has been possible makes for a fairer comparison of surgical units than the “raw” or unadjusted data reported in previous LCCOP reports.

 

Links

Click here to download a PDF of the 2016 (2014 data) LCCOP report.

Click here for a further summary of the national data from LCCOP 2016 (2014 data).

Click here to access the LCCOP methodology report submitted to HQIP.

Click here to download an Excel file with the unit level data from LCCOP 2016 (2014 data).

Click here for a link to patient information on lung cancer from the Roy Castle Foundation.