Lung cancer pathway

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Reports and resources to understand and tackle inequalities in lung cancer outcomes.

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Currently, the ACE Programme is focused on reducing unwarranted variation in access to diagnostics and treatment, for patients diagnosed with lung cancer. The National Lung Cancer Audit (for the period 2017) reports that, 'one in five patients with potentially curable disease do not receive optimal treatment'. We are exploring factors that are driving these unwarranted variations, from why some patients may choose not to undergo surgery to biases in the design of local health systems.  

Using a case-study approach, ACE is developing good practice approaches that help resolve some of these root causes of variation. The focus is on ensuring consistent diagnostic and treatment options are being offered to patients who present with similar profiles. 

We will publish the case studies when we have our findings. 

Our previous ACE Wave 1 projects explored various ways of streamlining lung cancer pathways. The below reports provide practical information on ways to achieve 'better practice' and includes a set of clear recommendations.

Executive Summary      Full report

The aim of this project is to assess potential delay points in lung cancer patients receiving their diagnosis, using linked national datasets, to provide a large scale understanding of common pathways and interval timings.

Pathway Analysis

During Wave 1 of the Programme several projects were piloted along the lung cancer pathway. Here you can find documents relating to the projects.

Cluster Outputs

Interim lung cancer pathways report
Qualitative research - telephone survey results
Straight to CT quick reference guide
Days to diagnosis chart


A14 Horsham and Mid-Sussex
The project will develop a new pathway for cancer patients going to Brighton and Sussex University Teaching Hospitals (BSUH), which will involve straight to CT following an abnormal Chest X-Ray.
Project Evaluation

A16 Nottingham City
Through direct access to CT by GPs, when locally agreed criteria have been met, the project aims to improve 2WW pathway flow and appropriateness of straight to test and one stop clinics referrals.
A60 Somerset
The projects will complete an audit to review and establish key reasons for delay in presentation with lung cancer as well as develop and implement an integrated and streamlined lung pathway.
Project Evaluation

A71 Manchester Cancer and The Christie NHS Foundation Trust
The project will perform a data analysis to drive improvement of sectorised model of care, measurement and performance management and define quality standards of lung cancer pathways in Manchester.
Project Evaluation

A77 North Staffordshire University Hospital
To introduce a system by which abnormal Chest X-Ray automatically triggers a CT scan request by radiologist, GP informed and eGFR requested – to reduce the anxiety of non-cancer patients and improve diagnostic investigation time for cancer patients.
A87 Crawley
By developing a straight to CT following an abnormal Chest X-Ray pathway, the project has many aims including; promoting joined-up working between primary and secondary care and improving lung cancer survival rates through earlier detection.
Project Evaluation

Can’t quite find what you are looking for?
Please see the list of documents available upon request

This cluster of wave 1 projects considers which proactive approach provides the most cost-effective method of finding undiagnosed early stage lung cancer; one project explores self-referral to chest x-ray.

Cluster outputs

Proactive Lung Report (with economic evaluation)
Proactive Lung Report Economic Evaluation

Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: The Liverpool Healthy Lung Programme - This document is available upon request here


A33 Manchester, Lancashire and South Cumbria
The project aims to achieve a step change improvement in earlier diagnosis by utilising a risk-stratification process to identify people at highest risk of lung cancer; and then offering them a low dose CT scan as well as targeted smoking cessation advice and support.
A51 Liverpool
The project will raise awareness of respiratory health and illness in communities with high incidence of lung disease and lung cancer. Members of the project will also work with GP practices to risk assess people, and offer low dose CT to those who meet agreed criteria.
Liverpool - Breathe freely leaflet
Liverpool - Lung health clinic CT scan FAQs leaflet
Liverpool - Lung health clinic nodules information leaflet
Liverpool - lung health clinic referred for a CT scan FAQs leaflet
Liverpool - Patients not referred for CT healthy lung
A64 Mid Cheshire
The project is focusing on health prevention and promotion of healthy lungs as well as the introduction of a self-request Chest X-Ray service targeted at populations where incidence and mortality is high.
Service evaluation report
A90 London, University College London (UCL)
UCL’s Health Behaviour Research Centre and Lung’s for Living Research Centre will pilot a lung screen uptake trial across UCLH and Homerton.
A91 Nottingham CCG
This project forms The Rebalancing Foundation which will support vulnerable populations access specialist care to improve lung health in North Nottingham. Areas covered includes lung disease, lung cancer and stop smoking services.
Nottingham - CT information form for lung health checks
Nottingham - Lung health check leaflet


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Last reviewed

1st touch communication approach

How positive and empathetic dialogue with patients can lead to an uptake in more curative treatment.

Explore the case study