Patients in London are receiving earlier lung cancer diagnosis and treatment thanks to an innovative way of performing lung biopsies at Barnet Hospital, Royal Free London NHS Foundation Trust.
Image-guided lung biopsy is crucial in lung cancer diagnosis, the leading cause of European cancer mortality with the survival rate in the UK the second-lowest in Europe. Despite huge therapeutic advances (such as gene-targeted drugs and lung radiofrequency ablation), UK lung biopsy practice has failed to evolve accordingly, leading to treatment delays and to patients often missing out on newer, cutting edge treatments altogether. In fact, patients with poor lung function are often declined biopsy due to their higher risk of developing lung collapse (pneumothorax), one of the most frequent complications of the procedure. This paradoxical practice is at direct odds with the very treatment advances tailored precisely for this patient group.
Most UK hospitals perform even uncomplicated lung biopsy as a day case procedure with routine 4-6 hours post-biopsy hospital admission. Equally, conventional management of significant post-biopsy lung collapse necessitates a minimum 24-48 hour hospital stay with the patient connected to a bulky, uncomfortable chest drain in order to help the lung re-inflate. Such practice uses up valuable and scarce hospital in addition to inconveniencing patients who often end up being hospitalised during an already anxious period while awaiting a potential lung cancer diagnosis.
Barnet Hospital’s lung cancer stakeholders recognised that access to lung biopsy under UK practice is suboptimal, with timely diagnosis of lung cancer jeopardised by dependence on hospital bed availability. Collaborative discussions between the radiology, respiratory and oncology services further highlighted a background of frail patients often refusing to undergo biopsy over concerns related to needing prolonged hospital admission in the event of post-biopsy lung collapse. Dr Sam Hare, consultant chest radiologist and head of radiology at Barnet Hospital, began piloting the new biopsy method in 2011 after highlighting that bed-related biopsy scheduling delays were unacceptable. This approach resulted in the creation of a radiology-led ambulatory lung biopsy service, entirely independent of hospital beds and with the ability to provide earlier lung cancer diagnosis in a wider range of patients.
The novel, ambulatory service means patients undergo lung biopsy entirely as outpatients, with the vast majority discharged just 30 minutes after the procedure. In addition, the new method enables successful treatment of a lung collapse at home through use of a discreet, unobtrusive device called a Heimlich Valve Chest Drain (HVCD). Use of this portable device has freed up multiple hospital beds – whilst also exponentially increasing the number of lung biopsies carried out each year and reducing costs by a staggering 90%. Furthermore, patient experience has significantly improved with HVCD use, creating less anxiety and upheaval as lung collapse does not mean an inevitable and prolonged hospital admission.
Barnet Hospital’s ambulatory lung biopsy service, which exemplifies the directives of the NHS 5-year Forward View, has been so successful that it has enabled the Royal Free London NHS Trust to perform hundreds more biopsies per year than the national average, including in patients who have been declined biopsy elsewhere due to poor lung function. This has in turn allowed quicker lung cancer diagnosis with earlier treatment, including with more novel therapies, in tandem with reduced patient and clinician anxiety regarding management of lung collapse.