National Lung Cancer Audit pleural mesothelioma report 2016
Data completeness
1. Data completeness for the performance status field should exceed 90%.
2. In anticipation of a validated International Mesothelioma Interest Group (IMIG) staging system planned for publication in 2017, clinical teams are encouraged to record the current non-validated IMIG tumour-nodes-metastasis (TNM) staging system at multidisciplinary team meetings for MPM patients. Once a validated staging system is available, hospital trusts should aim for an overall recording of stage in at least 90% of cases.
3. At least 95% of patients submitted to the audit should be discussed at a multidisciplinary team (MDT) meeting, ideally a mesothelioma specialist MDT.
4. All MDTs should appoint a ‘clinical data lead’ with protected time to allow promotion of data quality, governance and quality improvement.
Process of care
5. Pathological confirmation in life should be over 95%, as there are no specific clinico-radiological features for diagnosing mesothelioma. In view of its prognostic value, every effort should be made to pathologically subtype the MPM, and where the proportion of cases of unspecified MPM is above 10%, review of diagnostic procedures and pathological processing is recommended.
6. At least 90% of patients should be seen by a lung cancer nurse specialist (LCNS); at least 80% of patients should have an LNCS present at the time of diagnosis.
Treatment and outcomes
7. Patients with adequate performance status should be offered active treatment including palliative chemotherapy. MDTs with lower than expected chemotherapy rates (below 60%) or low risk-adjusted odds ratio should perform detailed case note review to ascertain why. High-quality patient information should be available to guide treatment decisions.
8. For patients undergoing surgical treatment, every effort should be made to accurately record the OPCS-4 code of the procedure undertaken.
9. All patients should be offered access to relevant clinical trials even if this requires referral outside of their network.
10. Survival: Where risk-adjusted odds ratios are low, an in-depth local audit is recommended, including analysis of active treatment rates and length of the diagnostic pathway.
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