Exploring variation across the lung cancer pathway – an interactive resource

The main purpose of the resource is to communicate the factors and interrelated causes that are driving unwarranted variation across the lung cancer pathway, in an easy to understand and visual format.  

It is intended to provide a simple and intuitive means to initiate local discussion, on how the root causes of variation impact the lung cancer pathway and start to consider what solutions might be available to resolve these issues.

The resource highlights five factors of variation:

  1. Service configuration - the availability, quality, and ease of access to local vs specialist lung cancer care will vary for patients across different areas.
  2. Patient Related - a patient’s awareness and emotional response to a cancer diagnosis combined with practical factors, may mean they make different choices about their treatment. 
  3. Healthcare professional related - assessments and recommendations can subtly differ based on healthcare professionals’ experience, expertise and preference.
  4. Resources - capacity such as access to the latest technologies and a skilled workforce, can be constrained by funding levels, impacting on options for patients.
  5. Coordination of services - if service provision is not coordinated and governed to ensure consistent quality assurance, it may introduce variation.

It’s important the user understands the definition of these factors before using the resource and how these might impact on the key decision points (GP referral, triage, MDT discussion) across the lung pathway.

We envisage the resource will be used by healthcare professionals working to streamline their lung cancer pathway and improve their curative treatment rates and overall outcomes.  This includes lung cancer MDTs, recognised cancer centres and secondary care trusts (i.e. hub and spoke networked services), cancer alliances, primary care networks and commissioners etc.

The resource supports healthcare professionals to understand and distinguish how the many service configuration and coordination challenges, resource constraints and patient and professional preferences can all contribute to the variation agenda.       

The resource is interactive, based on the parameters outlined in the NHS National Optimal Lung Cancer Pathway (NOLCP) for initially suspected and diagnosed lung cancers.

The resource also helps to communicate the focus of the current ACE Programme, in providing service design solutions/innovations to the factors that drive lung cancer variation, building traction for our evidence-based case studies that will follow in 2021.

How to self-assess for variation

The table below includes links to various sources of intelligence and comparative data that will help you assess your own local population characteristics.  

Please use this downloadable spreadsheet to help benchmark your local area and generate discussion on what areas to focus on.

It will also help you to understand and benchmark lung activity and outcomes for your local demographic area and beyond, prompting the search for unwarranted variation to help stimulate pathway and outcomes improvement.

Reference to pathways Overall title and web link Relevant data level Type of data and descriptions
Understand your population characteristics to help design the pathway effectively PHE Local Health LA, CCG, Ward Population by age group, proficiency in English, index of multiple deprivation, CGSE achievement, smoking prevalence, emergency admission for COPD, incidence lung cancer, life expectancy population, black & minority ethnic population, (2018)
PHE Healthier Lives LA Benchmarking LA against the best and worst within the same Index of multiple deprivation (2019) decile group.
Deprivation group, tobacco control, smoking prevalence in adults (18+) - current smokers (APS), Smoking status at time of delivery
Respiratory services in your area PHE National general practice profiles CCG, GP Respiratry disease/COPD prevalence, smoking prevalence, diagnosis, spirometry, MRC dyspnoea, FEV1 (2019-20)
Atlas of variation CCG The Atlases of Variation help to identify unwarranted variation and assess the value that healthcare provides to both populations and individuals (PHE, NHS England and Right Care and many other organisations) see: 2nd RespiratoryAtlas_v1.0_20190923.pdf – data based on 2015-17 and 2017-18
How do your patients see your services NHS England – cancer patient satisfaction LA, CCG, Trusts Trend data – presents 5 years trend data. Scores at a trust level are shown for Q1 to Q60.
Breakdowns – presents 5 years trend data. Scores at a trust level broken down by background information variables.
Overall experience – presents 5 years trend data. Scores for Q61 at trust level broken down by background information variables.
Referral to your lung cancer services

PHE Cancer services



Two-week wait referrals for suspected lung cancer (Number per 100,000 population)
(CCG 2019-20)
NHS England - Cancer waiting time Trusts Q4 2020-21 Cancer Waiting Times Provider Workbook Final (https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-wait...)
Access to imaging and GP direct access in your area NHS England - Diagnostic Imaging Dataset CA, Trusts

The Diagnostic Imaging Dataset (DID) is a central collection of detailed information about diagnostic imaging tests carried out on NHS patients, extracted from local Radiology Information Systems (RISs) and submitted monthly

  • DID table 1-2-3 -2019-20 - modality provider (counts, request to tests, test to report)
  • DID table 4-5-6 - 2019-20 - body site provider table (all and GP direct access) (counts, request to tests, test to report)
Time length of your pathway The Cancer Alliance Data, Evidence and Analysis Service (CADEAS) CA, CCG Median Pathway Analysis – Cancer Alliances – Lung Cancer- 2013-17
Analysis of 62-day pathways using 2017-18 Cancer Waiting Times data for colorectal, lung and prostate cancers - Cancer Alliance reports by CCG (19)
Your performance against the national lung cancer audit indicators   National Lung Cancer Audit CA, Trusts The National Lung Cancer Audit (NLCA) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and works with specialists to collect hospital and healthcare information and report on how well people with lung cancer are being diagnosed and treated in hospitals across England, Wales, (and more recently) Jersey and Guernsey.
Reports and data designed for local lung cancer teams, commissioners and patients/carers
Epidemiology of lung cancer in your area: Incidence/ mortality/ survival PHE - CancerData CA, CCG, STP CancerData is the main portal to all open access sources of NCRAS cancer data.
Incidence - 2018, mortality - 2018, survival (2003 - 2018), Prevalence by cancer type (1995-17), Routes to Diagnosis (2006 to 2016), Stage at Diagnosis (2001-18), Treatment Breakdown (2013-16), Radiotherapy delivery by tumour type - curative/palliative (2009 -20), Diagnostic Intervals – (2014-15)
Real time data of your services

The NCRAS CancerStats portal incidence statistics (requires a Health and Social Care Network (N3) connection)

CancerStats is a secure portal, powered by SAS solutions, which enables key stakeholders of the National Disease Registration Service (such as medical professionals, hospital cancer teams, and commissioners involved in patient cancer care to generate reports using NDRS data on a self-service basis. Authorised access allow benchmarking against other geographical parameters.

CA, CCG, Trusts


Access to:

  • COSD reporting portal

  • Radiotherapy (RTDS) and Systemic Anti-Cancer Therapy (SACT) reporting

  • Incidence, Mortality and Prevalence

  • National Lung Cancer audit

  • Cancer Alliance Data, Evidence and Analysis Service (CADEAS)

Level 2 data – 2020 - raw data
Level 3 data – QA 2018 – published data

Contact ACE

If you have any reflections or comments on the interactive tool, please get in touch with ACE at ACEteam@cancer.org.uk
The Accelerate, Coordinate, Evaluate (ACE) Programme evaluates a range of innovative approaches designed to improve cancer pathways. Using a case-study based analysis, ACE is developing a compendium of best practice approaches that can help to resolve some of the identified root causes of lung cancer variation. Please contact us if you would like more information or have examples of good practice you would like to share.

*Royal College of Physicians, National Lung Cancer Audit – Annual Report (for the audit period 2018), August 2020