Quality measurements for the Lung Cancer Registry of Norway
The main objective of the National Quality Registry for Lung Cancer is to contribute to mapping the assessment and treatment given to lung cancer patients to ensure that it is in line with the National Action Programme with guidelines for diagnosis, treatment and follow-up of lung cancer, regardless of place of residence.
The Lung Cancer Registry collects data on the assessment and treatment of this patient group. The purpose is to use the data from the registry to illustrate practice in hospitals and can be helpful in assessing practice in individual hospitals and for the patient group as a whole.
The Cancer Registry of Norway and the Professional Council cooperate with the Norwegian Directorate of Health to give a selection of the professional community's quality objectives the status of a national quality indicator. For lung cancer, curative treatment and five-year relative survival are national quality indicators.
In order to assess the health care provided to patients with lung cancer, the professional council has developed specific quality indicators:
The results show good coverage for the assessment report and the surgery report. Over the past four years, assessment reports have been submitted for more than 80 % of patients diagnosed with lung cancer.
The proportion of patients with lung cancer in Norway who receive curative treatment, either in the form of surgery, stereotaxy or a combination of drugs and radiation in curative doses, remains on a par with the previous year, just below 40 %.
Five-year relative survival for both sexes in 2022 is the highest ever in Norway, at 30%. The Academic Council decided to increase a high degree of goal attainment to 25% or higher in 2018. Few health trusts have results that are lower than this, only Innlandet HF and Telemark HF are significantly lower than the national average.
Among patients who undergo surgery for stage I lung cancer (localised cancer without lymph node metastases), more than 80 % undergo surgery with modern whooping hole surgery. This is a welcome development away from the traditional open operations, which are more extensive.
In order to determine whether a patient is available for curative treatment or not, PET-CT is considered an important part of the assessment. Therefore, this target has been set very high, ≥ 95%. Likewise, it is important to discuss fully assessed patients in a multidisciplinary meeting in order to determine the correct level of treatment. This is especially important for patients who may be available for treatment with curative intent. Therefore, the target figure has also been set very high for this indicator. Ideally, the proportion here should be even closer to 100%.
Previous reports from the Lung Cancer Registry of Norway have aimed to increase the proportion assessed in interdisciplinary (MDT) meetings and the proportion examined with PET-CT in the primary assessment. This has been worked on and there has been an increase in both of the aforementioned quality indicators, but the target of 95% has still not been reached. Work on this will continue.
A third measure has been that all health trusts should reach the target of 35 % for curatively treated patients. Here, the Cancer Registry of Norway has taken the initiative for a quality improvement project that was carried out in spring 2022. The Cancer Registry, in collaboration with representatives from OUS, Innlandet Hospital Trust and Telemark Hospital, took a closer look at the figures on curative treatment, and possible measures.
The annual report from the Lung Cancer Registry for 2021 showed an increased proportion of curatively treated patients at both Innlandet Hospital Trust and Telemark Hospital Trust. Both health trusts exceeded the stated goal attainment of 35 %. We see the same now for 2022. Innlandet Hospital had 39 % curatively treated patients in 2022 and Telemark Hospital had 35 %, an improvement from 33 % and 30 % respectively in 2018.
Identification of patient-oriented areas for improvement:
- The proportion examined with PET-CT in the primary assessment is still not above the target set, and several health trusts vary considerably from year to year
- There are large differences in the proportion of patients who undergo an EBUS examination
- All the health trusts should reach the target for the proportion of curatively treated patients of 35 %, there are still large differences between the health trusts
- There are major differences in the withdrawal of lymph nodes
In 2022, lists were sent to UNN to quality assure their low proportion of PET-CT registered with the Cancer Registry of Norway in 2020 and 2021. UNN has worked on the quality of the report and worked to report it within two weeks. The proportion of patients examined with PET-CT has increased from 80% in 2021 to 93.8% in this year's report.
The Advisory Council has focused on the considerable spread in the use of EBUS between the health trusts with analyses in the annual reports in recent years. In the annual report from 2021, there was a particular focus on the correlation between too few patients being assessed with EBUS and that there is less correspondence between cTNM and pTNM. Nationally, the proportion of lung cancer patients being examined with EBUS has increased from 21.3% in 2020 to 41.7% in 2022, yet these figures do not say anything about the quality of the survey conducted. The Academic Council will continue to monitor developments.
There are still large forebases in the extraction of lymph nodes. Further analyses will be conducted, which investigate the withdrawal of lymph nodes and the correspondence between cTNM and pTNM.
The Lung Cancer Registry registers variables that can help increase patient safety. The registry contains complications and/or adverse events in connection with surgery:
• Reason why the patient is found unresectable during surgery (advanced disease, medical complications or other causes)
• Withdrawal of lymph nodes and surgery beyond lung resection
Information on functional status (ECOG) is collected for both primary assessment and surgery.
In order to further strengthen the quality of health services, the Cancer Registry of Norway has in 2019 and 2020 worked on planning and building an infra structure for the collection of PROM and PREM (patient-reported outcome and experience measures), including integration with ePROM, which is the national solution for obtaining PROMs.
During 2022, all of the Cancer Registry's quality registries will collect PROMs data. There is no legal basis in the Cancer Registry Regulations for collecting PROMs, and the collection therefore has its basis for treatment in the Regulations relating to population-based health surveys. The National Quality Registry for Lung Cancer starts with routine collection of PROMs/PREMs in 2022.
So far, the response rate is low, as has been seen with the introduction of PTOM/PREM for other cancer groups. It is hoped that the response rate will increase as this becomes known in the community, both among patients and health personnel.