25 Years of The Liverpool Lung Cancer Unit

This April 2025, Liverpool Lung Cancer Unit colleagues are marking twenty-five years of their outstanding service.  

Background

The prevalence of lung cancer in Liverpool is far greater than the national average. It is the commonest cancer in the local population and the highest cause of cancer death. Unlike many other cancers, it often presents “late” and up to a third are only diagnosed after an acute admission to hospital. To tackle this, in April 2000 clinicians working between The Cardiothoracic Centre (now known as Liverpool Heart and Chest Hospital) and the Royal Liverpool University Hospital (now part of Liverpool University Hospitals Foundation Trust) created the Liverpool Lung Cancer Unit. This brought together the inpatient facilities of a large district general hospital with the diagnostic and investigative capabilities of a dedicated specialist unit, with the aim to provide seamless care for patients through the diagnostic journey. The service demonstrates an enduring collaboration between different NHS Trusts for the benefit of patients and their families. The service was set up as a rapid “one stop” diagnostic service, with onward referral at one week, but this has evolved as new methods of working, technological advancements, and new treatments have become available. The Liverpool Lung Cancer has always been at the forefront of national lung cancer innovation. For example, it was the first to adopt a multidisciplinary team approach to lung cancer working and it was the first to introduce the concept of “flagging” a potential lung cancer diagnosis on radiological imaging to facilitate timely investigation. These are both now standard practices in cancer management throughout the UK.

Changes

In January 2014, the ‘straight to CT’ model was introduced, whereby an abnormal chest X-ray ordered by a GP would prompt a chest CT scan without the need for clinician intervention, thereby removing a common delay in the diagnostic pathway. This innovation meant that patients without lung cancer could be quickly reassured, avoiding prolonged distress and anxiety, whilst those who needed further investigation could be provided with a timely diagnosis.

Virtual Clinics

At the same time, the service launched ‘virtual’ clinics, whereby following a remote assessment by the medical team, the specialist lung cancer nursing team would contact the patient and offer the next test, abolishing the need to be seen in a traditional clinic which simply adds delays into the pathway. In 2016, NHS England published the national optimal lung cancer Background Changes Virtual clinics Achievements Future pathway. The Liverpool Lung Cancer Unit model of care was considered when developing this pathway. The specialist lung cancer nursing team is pivotal in the smooth running of this service, building a strong rapport with the patient through the journey from diagnosis to treatment. Care is individualised, holistic and the team work to improve symptoms, whilst offering detailed explanations and preparing them for any tests or treatment. Patient feedback from these virtual clinics is exceptional. Often the virtual appointment provides an opportunity for patients to talk more openly. However, virtual clinics may not suit everyone, and mindful of this the option is always available for in-person appointments. The service is so effective that during the pandemic there were no delays in the patient journey and the Liverpool Lung Cancer Unit helped the Aintree Lung Cancer Unit by managing all their suspected outpatient lung cancer cases from the north part of the city.

Achievements

Getting It Right First Time (GIRFT), a programme to help improve the quality of care within the NHS, undertook a review of the lung cancer service in 2020. The findings were outstanding, and the service was lauded nationally as exemplar practice. Throughout the past 25 years, the service developed the skills and expertise of experienced colleagues, who have worked tirelessly to impact thousands of lives. The service diagnosed over 500 people with lung cancer in 2022 alone.

Future

The future now looks brighter for lung cancer care. Colleagues from the Liverpool Lung Cancer Unit were at the forefront of the Liverpool Healthy Lung Programme which began in 2016, and later transitioned to a national Targeted Lung Health Check (TLHC) Programme in 2021. This programme works with communities across Liverpool, Knowsley, Halton, St Helens and South Sefton to diagnose cancer in its earliest stages, often before symptoms occur. Around 80% of lung cancers diagnosed within the TLHC services are at stage 1 and 2 (suitable for curative treatment). Ultimately this means thousands of lives can be saved if lung cancer is identified earlier and treated swiftly – a significant and welcome shift for our patients from where we started 25 years ago.