ES26.01 The Impact of Specialist Nursing Intervention in Lung Cancer

Abstract

Introduction In the UK the role of the Clinical Nurse Specialist is well established. Lung Cancer Clinical Nurse Specialists (LCNS) often start a therapeutic relationship with patients and families before formal diagnosis has been made. LCNS often manage the care of people with lung cancer but in an environment of austerity their worth to employers is still questioned. This series of studies examined the impact of the LCNS on outcomes for lung cancer patients. The focus of this abstract is one of the studies which looks at receipt of treatment for lung cancer. Treatment choices for people with lung cancer may be influenced by contact and engagement with lung cancer nurse specialists (LCNSs). We investigated how service factors, LCNS workload, and LCNS working practices may influence the receipt of anticancer treatment. Materials and methods English National Lung Cancer Audit data and inpatient Hospital Episode Statistics for 109,079 people with lung cancer surviving 30 days from diagnosis were linked along with LCNS workforce census data and a bespoke nationwide LCNS survey. Multinomial logistic regression was used to determine adjusted relative risk ratios (RRRs) for receipt of anticancer therapies associated with LCNS assessment, LCNS workforce composition, caseload, LCNS reported working practices, treatment facilities at the patients’ attending hospitals, and the size of the lung cancer service. Results Assessment by an LCNS was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments being particularly associated with greater receipt of surgery (RRR 1.85, 95%CI 1.63–2.11). For people we considered clinically suitable for surgery, receipt was 55%. Large LCNS caseloads were associated with decreased receipt of surgery among suitable patients (RRR 0.71, 95%CI 0.51–0.97) for caseloads >250 compared to ≤150. Reported LCNS working practices were associated with receipt of surgery, particularly provision of psychological support (RRR 1.60, 95%CI 1.02–2.51) and social support (RRR 1.56, 95%CI 1.07–2.28). Conclusion LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy. Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable Early nurse specialist contact is associated with greater receipt of therapy. •Receipt of surgery is less likely where nurse specialists have large caseloads. •Therapy receipt is more likely if key nursing interventions are routinely provided. •Managing nurse specialists’ workload could address disparities in therapy uptake. Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? (2018) Stewart, Iain et al. Lung Cancer, Volume 123, 160 – 165 https://www.lungcancerjournal.info/article/S0169-5002(18)30482-3/pdf Nursing, Advanced practice, treatment