LUCADA PATIENT DATA FORM
Demographics
NHS Number
Forenames
Sex
Postcode
Organisation Code
Surname
Date of Birth
Referral Information
 Following an emergency admission
 Referral from consultant other than in A&E
Source of
 Following A&E attendance
referral
 Community Dental Service
 Not known
Date of decision to refer (2-week patients only)
Lung cancer specialist referral date (non-2-week patients)
Date first seen
Place first seen
 Following a domiciliary visit
 Referral from GP
 General Dental Practitioner
 Other source of referral
Investigations
Had a CT scan?
Had a PET scan?
Had a bronchoscopy?
Had a CT-guided biopsy?
Had other diagnostic biopsy?
 No
 No
 No
 No
 No
 Yes........Date:
 Yes........Date:
 Yes........Date:
 Yes........Date:
 Yes........Date:
Diagnosis
Date of diagnosis
Place of diagnosis
Pre-treatment histology
Primary
site
diagnosis
 Bronchus or lung, unspecified
 Main bronchus, Carina, Hilus of lung
 Middle lobe/lingular, bronchus or lung
 Trachea
 Mediastinum, part unspecified
 Malignant neoplasm of heart,
mediastinum and pleura
 Mesothelioma
Laterality
Basis of diagnosis
 Malignant neoplasm of bronchus or lung
 Upper lobe, bronchus or lung (incl. pancoast)
 Lower lobe, bronchus or lung
 Overlapping lesion of bronchus and lung
 Pleura
 Overlapping lesion of heart, mediastinum and
pleura
 Mesothelioma of pleura
 Left
 Midline
 Bilateral
 Unknown
 Death certificate
 Clinical investigation
 Cytology
 Histology of a primary tumour
 Right
 Not applicable
 Clinical
 Specific tumour markers
 Histology of a metastasis
 Unknown
Staging
Staging procedure performed?
Mediastinoscopy/Mediastinotomy
FNA staging procedure performed?
Other staging procedure performed?
Unknown staging procedure performed?
Pre-treatment Stage
NSCLC Stage
SCLC Stage
T
N
M
Will be calculated based on TNM above
 Limited
 Extensive
 Unknown
Page 1 of 4
LUCADA PATIENT DATA FORM
Care Plan/MDT
Discussed at MDT?
Treatment intent
Treatment modalities
Suggested plan
 Yes…….Date:
 No
 Unknown
 Curative
 Palliative
 Palliative (supportive care only)  Unknown
 No specific anti-cancer treatment
 Single modality
 Multiple modality
 Unknown
 Surgery
 Radiotherapy
 Chemotherapy
 Brachytherapy
 Palliative care
 Active monitoring
 Sequential chemotherapy and radiotherapy
 Concurrent chemotherapy and radiotherapy
 Induction chemo to downstage before surgery
 Neo-adjuvant chemotherapy and surgery
 Surgery followed by chemotherapy
Co-Morbidities
Was there any reason why the
patient did not receive the first
choice of treatment?
 Died
 COPD
 Refused
 Co-morbidity precluding treatment
 Dementia/Cerebrovascular
disease
 Renal failure
 Severe weight loss
Co-morbidities
FEV1 Absolute
FEV1 percentage
Performance Status
0
1
2
3
 Cardiovascular disease
 Other malignancy
 Other
4
 Not recorded
Treatment - Surgery
Hospital code
Date of decision to operate
Date of surgery
Main surgical
procedure
Completeness
of resection
 Wedge resection of lesion of lung
 Multiple wedges resected
 Segmental resection
 Sleeve resection
 Lung resection with resection of chest wall (not identifying which
lobe resection)
 Carinal resection
 Lobectomy
 Pneumonectomy
 Open operation on lung (open and close)
 Bilobectomy
 Other open operation on lung
 Extrapleural pneumonectomy
 Debulking pleurectomy
 Pleurodesis
 Presence of
 No residual
 Microscopic
 Macroscopic
residual tumour
tumour
residual tumour
residual tumour
cannot be assessed
Surgical histology
Date of surgical histology
Pathological stage
Pathological NSCLC Stage
Pathological SCLC Stage
pT
Page 2 of 4
pN
pM
LUCADA PATIENT DATA FORM
Treatment - Chemotherapy
Hospital code
Date of decision to treat
Date of start of treatment
Chemotherapy intent
 Chemotherapy alone
 Neo-adjuvant chemotherapy before surgery
 Part of a chemotherapy / radiotherapy treatment plan
 Adjuvant chemotherapy post surgery
 Induction chemotherapy to down stage before surgery
Treatment - Radiotherapy
Hospital code
Date of decision to treat
Date of start of treatment
Radiotherapy site
Radiotherapy intent
 Trachea
 Lung
 Mediastinum
 Skin
 Chest wall
 Bone
 Mesothelioma drain site
 Other Region of Body
 Brain
 Curative (radical) radiotherapy
 Curative (CHART / CHARTWEL)
 Part of a chemotherapy / radiotherapy treatment plan
 Adjuvent following surgical treatment
 Palliative Radiotherapy
Treatment - Brachytherapy
Hospital code
Date of decision to treat
Date of start of treatment
Treatment – Palliative Care
Hospital code
Date of decision to treat
Date of start of treatment
Palliative Care Provider Type
Palliative Care Community Provider
Palliative Care Intervention Given
 Hospital
 Community
 Hospice
 Nursing Home
 Home care
 Other
 Unknown
 No
 Yes........Date:
Treatment – Active Monitoring
Hospital code
Date of decision to treat
Page 3 of 4
LUCADA PATIENT DATA FORM
Outcomes
Trial status
Date of death
Was death treatment-related?
Morbidity type
Was PCI given
Was the original plan carried out?
Reason for failure of original plan
 Patient eligible, consented to and entered trial
 Patient not entered into clinical trial
 Clinical trial status unknown
 Yes
 No
 Unknown
 Surgery
 Chemotherapy
 Radiotherapy
 Combination
 Yes
 No
 Unknown
 Yes
 No
 Unknown
 Cancer progressed through treatment such that a
new treatment plan required
 Patient choice
 Patient died
 Treatment toxicity
 Disease progression
Lung Cancer Nurse Specialist
Was patient assessed by LCNS?
Date of first assessment by LCNS
How was patient first assessed by LCNS?
At what stage was the patient assessed
by LCNS?
Was LCNS present when patient received
their diagnosis?
 Yes
 No
 In clinic
 Ward Visit
 Other
 Not recorded
 Before diagnosis
 Before and after diagnosis
 Unknown
 Yes
 No
Notes
Page 4 of 4
 Unknown
 Home visit
 Telephone
 Unknown
 After diagnosis
 At diagnosis only
 Not recorded
 Unknown