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The UK national health system needs to look closely at its priorities and procedures in order to ensure that rapid advances in the molecular diagnosis of lung cancer result in a practical service for all patients, according to a report published today by the British Thoracic Oncology Group Conference.
The UK's largest multi-interest group in lung cancer has published a detailed and practical report that highlights the urgent need for change, to help the UK track the progress of lung cancer treatments. The UK has one of the worst lung cancer survival rates in five years in Europe1 and the NHS would be slow to respond, with "uneven" services.2
While the constant discovery of new targets and agents is encouraging, it is preventing clinicians, pathologists and drug regulators from keeping up.
The lack of personnel in pathology laboratories is certainly not unrelated. only 3% of the departments that responded to the Royal College of Pathologists Histopathology Labor Force Survey in 20183 said that they had enough staff.
Professor John Gosney (Thoracic Pathology Consultant, Royal Liverpool University Hospital), who played a key role in the UKLCC's Molecules Matter report, said:
"We need to appoint thoracic pathologists interested in molecular diagnosis. This recruitment could be done nationally with planned placement in selected existing centers of excellence, where expanding services are often currently managed by a single overburdened pathologist. Centralization of thoracic pathology services is impossible without this. "
The report was written by the UK Coalition Against Lung Cancer (UKLCC), a coalition of leading UK lung cancer experts, top NHS professionals, charities and healthcare providers. health.
The aim of the UKLCC is to raise public and public awareness of lung cancer, improve lung cancer treatment services and empower patients to a) recognize early symptoms and b) empower patients to take part in their care.
When asked if there were countries in the world that distinguished themselves as "ahead of the game," Professor Gosney said:
"No country has solved these problems, which are the same everywhere."
As a result, this pioneering group is working to put in place measures to ensure that pathology and molecular diagnostic services can keep pace with the changing treatment landscape.
The following is a summary of some of the recommendations listed in the report:
| Technical | Organizational | Professional | The data |
| Biomarkers and diagnostic tests should be evaluated regularly by NICE and NHS England | Services should aim for the goals of the national optimal lung cancer pathway | Pathology and Genomics Laboratory Centers Need to Communicate Effectively | Reporting templates should be developed and managed on a national LIMS system |
| National genomic test directories should be updated regularly. ad hoc base – not annually | Inform patients as much as possible about next steps, time limits, etc. | Cellular pathology staff is under pressure; the budget has to be set aside for this | Diagnostic test data must be linked to other patient data to guide treatment. |
| Will the tests be reflexive or on demand? * | Ensure fast and efficient movement of samples | Control and address: is there a lack of biomedical students? In which areas? | It should be mandatory to submit high quality data to a national dataset. |
| Next Generation Sequencing Panels vs. Multiple / Unique Gene Testing * | Pathologists: Follow the Royal College of Pathologists guidelines for lung cancer | The training of those who take tissue samples must be standardized | A report scheduled for 2020 should be used to monitor services, identify trends and reduce variations |
* Services must clearly indicate when they will be used.
Divergence in the decentralized nations
Another group of challenges was also highlighted, namely "divergence in decentralized countries". In other words, there are differences between England, Scotland, Wales and Northern Ireland in terms of funding models, access to medicines and screening options. However, this presents learning opportunities based on best practices:
"This lack of alignment across the UK has resulted in a contrasting picture of funding for new diagnostic tests in Northern Ireland and Wales. Northern Ireland has until recently had no access to the Cancer Drugs Fund (CDF), so patients could not access ROS1 to date. In Wales, however, the One Wales system, which uses a generic panel for solid tumors, has taken a big step forward. "
Coherence needed in fabric sampling
According to Professor Michael Peak, chairman of the UKLCC's clinical advisory group, there should be a quality badurance program for those involved in collecting tissue samples. In the preface of the report, he writes:
"The range of tissue sampling techniques has also expanded in recent years, particularly with the development of endobronchial ultrasound (EBUS) mediastinal sampling and the use of more widespread needle guided biopsy by scanner. The growing range of pathological tests requires larger and better tissue samples. In addition, there is strong, albeit largely anecdotal, evidence of significant variation in the quality of samples received by pathology laboratories. "
Asked about this variant, Professor Gosney said:
"There are two reasons for inadequate samples for profiling lung cancer; poor technique of endoscopy or radiologist performing procedure (endobronchial ultrasound, needle biopsy, etc.) and wastage of tissue by inexperienced and non-specialist pathologists, usually in district general hospitals (DGH ), performing unnecessary immunochemistry prior to the initial diagnosis referring the specimen for profiling. These services should be centralized. "
So having a sufficiently trained staff is the key. Funding seems to be lacking, but are training opportunities really available?
"Training opportunities already exist in the laboratories of the existing large thoracic centers; posts should simply be created with the necessary funds, "notes Professor Gosney.
Goals have been set, it's time to act!
According to the report, a diagnostic level of 85% should be achievable when the defined tumor is visible. To achieve this, a coordinated strategy will be needed. The frontier in pathology and molecular diagnostics is called "evolving at a rate," but there are many barriers to making these advances accessible to patients.
As Professor Peake concludes:
"If the UK wants to get the best cancer results in the world,4 then these problems need to be addressed, and urgently! "
References:
1. London School of Hygiene and Tropical Medicine: CONCORD Program Cancer Control Team, via: http://csg.lshtm.ac.uk/research/themes/concord-programme/
2. Molecules Matters: Making the science of molecular diagnostics in lung cancer a practical service for all patients. British Coalition Against Lung Cancer. January 2019. Available at: www.uklcc.org.uk/our-reports/
3. Royal College of Pathologists, 2018 Histopathology Workforce Survey
4. Independent Cancer Task Force, Achieving World-Clbad Cancer Results: A Strategy for England 2015-2020, July 2015
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