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Lung cancer Quality Performance Indicators

Lung cancer quality performance indicators (QPIs) are used to improve the quality of cancer services and deliver better outcomes for people diagnosed with lung cancer.

Lung cancer is the leading cause of cancer death in Aotearoa. Lung cancer also contributes to inequities in health outcomes, with mortality rates three to four times higher for Māori compared with non-Māori. The Ministry of Health worked with the National Lung Cancer Working Group (NLCWG) to develop a set of proposed QPIs for lung cancer. This work transferred from the Ministry to Te Aho o Te Kahu in December 2019.

The Ministry of Health’s Cancer Services team, and NLCWG worked together to develop a set of QPIs for lung cancer. The first Lung Cancer Quality Improvement Monitoring Report, using 2015 – 2018 data, was published early 2021.

Quality Improvement Monitoring Report

The Lung Cancer Quality Improvement Report was published in 2021, covering the years 2015 to 2018. This report presents data for eight QPIs.

Te Aho o Te Kahu expects districts (previously District Health Boards prior to 1 July Health and Disability Reforms) will review their performance and, where unwarranted variation is identified, take action to improve their performance and patient outcomes. The differences noted in our findings and discussed in this report will also help guide national quality improvement programmes.

The reported QPIs in the Lung Cancer Quality Improvement Monitoring Report 2021:

  • Routes to diagnosis: Proportion of people with lung cancer who are diagnosed following a referral to a clinic or presentation to an ED, by stage
  • Pathological diagnosis: Proportion of people who have a pathological diagnosis of lung cancer
  • Surgical resection: Proportion of people with NSCLC receiving surgical resection with curative intent, by stage and ECOG performance status
  • Systemic anti-cancer therapy:
    • (i) Proportion of people with NSCLC receiving SACT, by stage and ECOG performance statu
    • (ii) Proportion of people with SCLC receiving SACT, by stage and ECOG performance status
  • Radiation therapy: 
    • (i) Proportion of people with lung cancer receiving SABR, by stage, ECOG performance status, intent, and type of lung cancer (NSCLC/SCLC)
    • (ii) Proportion of people with lung cancer receiving concurrent chemoradiation, by stage, ECOG performance status, intent, and type of lung cancer (NSCLC/SCLC) 
  • Treatment mortality: Proportion of people with lung cancer who died within 30 or 90 days of treatment with curative intent (surgery, SACT, radiation therapy), by type (NSCLC/SCLC) and stage
  • Overall survival: Overall survival for people with lung cancer at 1, 2 and 3 years from diagnosis, by type (NSCLC/SCLC) and stage
  • Cancer treatment at end of life: Proportion of people with lung cancer who receive SACT within 30 days prior to date of death. 
Reports:
Quality Performance Indicator Descriptions

The QPI descriptions report outlines the detailed evidence-based descriptions for each indicator including the numerator and denominator. This report should be read in conjunction with the monitoring reports. It includes indicators that can be measured, and those we term ‘aspirational’. These are important for clinical care quality improvement but there is currently no data available to measure and report on them. 

Quality Performance Technical Specifications

The QPI technical specifications report outlines method for calculating each QPI that is reported in the associated monitoring report. This method provides enough detail to replicate our calculations every three years. It provides information on data sources, numerator criteria, denominator criteria, relevant data codes and descriptions and data flow diagrams.

Improvement Plan (Action Plan)

This action plan should be read in conjunction with the monitoring report. Districts can review the monitoring report to identify where their performance is significantly different to other districts. This can then lead to quality improvement principles to plan for and implement improvement projects in those areas.

The ‘recommended actions’ set out in this plan are intended as a guide to the types of actions districts or hospitals could take to improve their performance. Districts and hospitals can develop and implement local quality improvement plans with actions appropriate to their local context and priorities.

We note some districts and hospitals are already undertaking quality improvement work. The recommendations in this action plan do not prevent additional actions or the DHBs and hospitals continuing to follow existing effective quality improvement activities.

National Lung Cancer Working Group

Role
In October 2009, the Regional Cancer Networks and the Ministry of Health Cancer Team invited clinicians and other parties with an interest in thoracic malignancy to a meeting to gain agreement on the development of a National Lung Cancer Working Group (NLCWG). The aim of this group has been to achieve national consistency in the care of patients with thoracic malignancy.

The NLCWG was formally established early 2010 once the terms of reference, membership, and a proposed work programme was agreed. The NLCWG has been responsible for developing several guidance documents, standards, and toolkits. It has maintained relationships with key stakeholders, as well as supported initiatives related to research, clinical education, and lung cancer public awareness campaigns.

Terms of reference

Word - National Lung Cancer Working Group Terms of Reference 

PDF - National Lung Cancer Working Group Terms of Reference 

Membership

Chair

  • James Entwisle - consultant radiologist, clinical director - Strategy, Innovation & Performance, Health New Zealand Te Whatu Ora – Capital, Coast & Hutt Valley

Members

  • Brendan Luey – clinical leader medical oncology, Health New Zealand Te Whatu Ora - Capital, Coast and Hutt Valley
  • Chris Harrington – consultant radiation oncologist, Health New Zealand Te Whatu Ora Canterbury
  • Claire Hardie - radiation oncologist, Health New Zealand Te Whatu Ora – MidCentral and joint chair, central region lung group
  • Denise Aitken - physician & palliative Care, Health New Zealand Te Whatu Ora – Lakes
  • Dianne Keip - cancer care coordinator, Health New Zealand Te Whatu Ora – Hawkes Bay
  • Felicity Meikle - cardiothoracic specialist, Health New Zealand Te Whatu Ora – Waikato
  • George Laking - medical oncologist, Health New Zealand Te Whatu Ora – Auckland; Chair of the Māori Health Committee of the RACP; board member of Hei Āhuru Mōwai Māori Cancer Leadership Aotearoa
  • Greg Frazer - respiratory and general physician, Health New Zealand Te Whatu Ora – Canterbury; clinical senior lecturer, University of Otago
  • Jeremy Hyde - consultant anatomical pathologist, Awanui Labs, Health New Zealand Te Whatu Ora - Nelson
  • Jonathan Adler - consultant palliative care, Health New Zealand Te Whatu Ora – Capital, Coast & Hutt Valley
  • Joseph Stafford - consumer and Māori representative
  • Mark Taylor - clinical director of primary and integrated care, Health New Zealand Te Whatu Ora - Waikato and specialist general practitioner
  • Paul Conaglen - cardiothoracic specialist, Health New Zealand Te Whatu Ora – Waikato
  • Paul Dawkins – Respiratory Physician, Health New Zealand Te Whatu Ora - Counties Manukau
  • Ross Lawrenson - professor of population health, University of Waikato; clinical director, Health New Zealand Te Whatu Ora - Waikato
  • Sean Galvin – cardiothoracic surgeon and joint chair, central region lung group.
Minutes

NLCWG Minutes 7 March 2023

NLCWG Minutes 29 November 2022

NLCWG Minutes 5 April 2022

NLCWG Minutes 16 November 2021

NLCWG Minutes 27 July 2021  ​​​

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