NNHLA FAQs

The National Non-Hodgkin Lymphoma Audit (NNHLA) evaluates patterns of care and outcomes for people diagnosed with non-Hodgkin lymphoma in England and Wales. It aims to highlight variations in care and to support NHS services to identify and address areas for improvement.

Alongside the NNHLA project team members; also involved in the work of the audit are the following key stakeholders: the wider NATCAN family, HQIP (our funders), clinical experts, allied health professionals, patient groups, charities, and representatives from NHS England and the Welsh Government.

People are included in the NNHLA if they are newly diagnosed with non‑Hodgkin lymphoma (NHL), as identified using relevant ICD‑10 or ICD‑O3 codes.

The following patients are excluded from the audit:
– Those identified with NHL through death certificate only.
– Those with pathology codes not related to NHL.
– Those diagnosed and treated outside an NHS organisation in England or Wales.

Non Hodgkin lymphoma (NHL) is one of the most common cancers in the UK, with more than 14,000 people diagnosed each year. It is also the only non solid tumour cancer included in the national cancer audit programme. Unlike solid tumour cancers, NHL is managed primarily by haematologists, and treatment relies on systemic therapies such as chemotherapy, sometimes alongside radiotherapy. Surgery has a limited role beyond diagnosis, meaning the patient pathway, the points where care can vary, and the decisions clinicians face differ significantly from those for solid tumour cancers.

We aim to ensure that everyone diagnosed with NHL across England and Wales receives the best possible care. By analysing patterns and variations in care from diagnosis through to treatment we aim to provide providers with clear and meaningful feedback on where care is strong and where improvements can be made. Our findings are publicly available to support transparency, quality improvement, and better outcomes for people affected by NHL.

You can sign up to receive periodic emailed updates from the NNHLA team by sending us an email to request this to: [email protected]

Yes, you can engage with us on the following social media channels:
LinkedIn National Non-Hodgkin Lymphoma Audit and Bluesky @nnhla-natcan.bsky.social. 

NHL subtypes can be classified according to their rate of disease progression, which influences the choice of treatment approach and subsequent prognosis.

– Low-grade or indolent NHL subtypes are characterised by slow disease progression, do not always require immediate treatment, but are harder to completely cure than high-grade NHL.

– High-grade or aggressive NHL subtypes are characterised by rapid disease progression, require immediate treatment, but respond better to treatment than low-grade NHL and can often be cured.

High-grade and low-grade classification of NHL subtypes included in the NNHLA were determined with advice from the NNHLA clinical experts.

The NHL subtypes reported in the State of the Nation include:
• Burkitt lymphoma
• Chronic Lymphocytic Leukaemia
• Cutaneous T-cell lymphomas
• Follicular lymphoma
• Large B-cell lymphoma
• Marginal zone lymphoma
• Mantle cell lymphoma
• NHL, not otherwise specified (NOS/Other (includes the more rare or mixed sub-types)
• Peripheral T-cell lymphomas

The NNHLA Quality Improvement (QI) intervention—launched in October 2025—aims to support trusts in improving the data quality submitted to the Audit. Trusts with less than 50% data completeness for Ann Arbor staging are identified and contacted by the Audit team. Only trusts in England are included in this intervention because it is supported by the quarterly dashboards which do not include Welsh Health Boards.

If your trust is invited to participate, we encourage you to refer to the initial invitation letter, which outlines the resources available to help improve data quality. You can also visit the Audit’s QI webpage for additional and regularly updated materials: https://www.natcan.org.uk/nnhla-quality-improvement-intervention.

You are very welcome to contact the Audit team at [email protected] for further support.

The ICD 10 and ICD-O-3 codes used in the NNHLA are detailed in the State of the Nation Report Methodology Supplement, where they are listed in the appendices.

The quarterly report is published every January, April, June and September. To receive the latest updates, you can subscribe to the Audit’s newsletter by emailing [email protected], and follow the Audit on LinkedIn National Non-Hodgkin Lymphoma Audit and Bluesky @nnhla-natcan.bsky.social.
You can also refer to the “Update” tab on the dashboard, which displays the date of the next scheduled release.

The latest list of NNHLA key COSD data items can be accessed on the NATCAN website at the following link:
https://www.natcan.org.uk/library/key-cosd-data-items

The NNHLA project team has built strong relationships with partners based at Lymphoma Action and Blood Cancer UK.

You can access the NNHLA’s Outlier policy here:
https://www.natcan.org.uk/library/natcan-outlier-policy-nnhla.