Lung Cancer Team Research Articles

Developing and Setting Up a Lung Cancer Triage Phoneline For Rural West Wales

The incidence of people diagnosed with and living with cancer in the UK is increasing and by 2030, 1 in 2 people will develop cancer (The Cancer Delivery Plan 2016-2020 WAG). Health care providers must explore innovative ways to provide quality care both in terms of outcomes and patient experience set against the challenge of finite resources. Within Wales there are over 2,300 patients diagnosed with lung cancer each year, however less than 20% of these are diagnosed at early stage when they are eligible for curative treatment. It has been shown that early diagnoses leads to improved survival.
 More than 90% of patients with lung cancer are symptomatic at diagnosis. 
 Rates of lung cancer diagnosis have been drastically impacted by COVID, with referral rates and presentation to GPs at an all-time low in 2020-21. Screening of patients by triage nurse will help reduce GP workload by allowing patients to be referred, for Chest X-ray, and then to Secondary Care for onward management.
 To improve early diagnosis of lung cancer, LUMEN (Lung Cancer Symptom Assessment Line) Nurse Led Service was developed with the following aims:
 
 To deliver a triage service that is safe, effective, equitable and accessible.
 Develop and launch this service and integrate into current lung cancer pathways.
 Promote and deliver the service and determine acceptability, feasibility, safety, and cost-effectiveness of the pathway.
 
 By increasing patient access to diagnostic testing, we hope to increase early diagnosis and subsequent patient outcomes.
 Patient benefits
 The Nurse will make onward referrals to lung cancer team, support the person throughout this journey and offer smoking cessation advice, if needed.
 Staff Benefits
 Role is varied and includes raising awareness of lung cancer symptoms, promoting the service, and liaising with various teams to improve patient journey.

Staging by Thoracoscopy in potentially radically treatable Lung Cancer associated with Minimal Pleural Effusion (STRATIFY): protocol of a prospective, multicentre, observational study

IntroductionRecurrence rate following radical therapy for lung cancer remains high, potentially reflecting occult metastatic disease, and better staging tools are required. Minimal pleural effusion (mini-PE) is associated with particularly high...

113 - The invaluable introduction of a cancer care co-ordinator into the lung cancer team

113 - The invaluable introduction of a cancer care co-ordinator into the lung cancer team

P1.07-04 Early Lung Cancer Team Intervention in Emergency Admissions

P1.07-04 Early Lung Cancer Team Intervention in Emergency Admissions

Alerting Unscheduled Lung Cancer Admissions: a novel system for monitoring and alerting the lung cancer team to emergency lung cancer admissions

Alerting Unscheduled Lung Cancer Admissions: a novel system for monitoring and alerting the lung cancer team to emergency lung cancer admissions

Salvage surgery for recurrent or persistent tumour after radical (chemo)radiotherapy for locally advanced non-small cell lung cancer: a systematic review.

Background:Once recurrent or persistent locoregional tumour after radical chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) is identified, few curative-intent treatment options are available. Selected patients might benefit from surgical salvage. We performed a systematic review of the available literature for this emerging treatment option.Methods:A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Publications about persistent or (locoregional) recurrent disease after radical/definitive CRT for locally advanced non-small cell lung cancer were identified.Results:Eight full papers were found, representing 158 patients. All were retrospective series and data were heterogeneous: definition and indication for salvage surgery varied and the median time from radiotherapy to surgery was 4.1–33 months. Complete resection (R0) was achieved in 85–100%, with vital tumour in 61–100%. A large number of pneumonectomies were performed, and additional structures were often resected. Where reported, 90-day mortality was 0–11.4%. Reported survival metrics varied but included median overall survival 9–46 months and 5-year survival 20–75%.Conclusion:There are limited, low-level, heterogeneous data in support of salvage surgery after radical CRT. Based on this, perioperative mortality appears acceptable and long-term survival is possible in (highly) selected patients. In suitable patients (fit, no distant metastases, tumour appears completely resectable and preferably with confirmed viable tumour), this treatment option should be discussed in an experienced multidisciplinary lung cancer team.

Impact of a Non-small Cell Lung Cancer Educational Program for Interdisciplinary Teams

Successful implementation of non-small cell lung cancer (NSCLC) evidence-based guideline recommendations requires effective educational programs that targetall clinicians from interdisciplinary teams. This study describes and evaluates the Engaging an Interdisciplinary Team for NSCLC (GAIN 3.0) experiential learning-based educational curriculum. GAIN 3.0 was designed to enhance interdisciplinary collaboration for effective NSCLC diagnosis, assessment, and treatment. The program used a flipped classroom model that included an e-learning component prior to a live 6-hour interactive program. The interactive program included hands-on simulations, small group workshops, gamification, and case discussions. Participants included academic and community members of multidisciplinary lung cancer teams. Assessments included an online baseline survey, a pretest and posttest, a program evaluation, a long-term survey (LTS), and on-site faculty evaluation of participants. Of 416 attendees to 13 live GAIN 3.0 programs (nine in the United States and four in Europe), 304 (73%) completed the pretest and 187 (45%) completed the posttest. Out of a perfect score of 12 points, program participants had a mean test score of 6.3 ± 2.1 on the pretest (52%) and 7.8 ± 2.1 on the posttest (65%) (P= .03). There was an overall knowledge increase of 13%from pretest to posttest. Most LTS respondents (65%) rated the GAIN 3.0 live programs as "high impact." On the LTS, the areas with the greatest gains in participants who had very high confidence were communication across disciplines, use of a team-based approach, and personalized treatment. GAIN 3.0 was a highly successful interdisciplinary activity that improved participants' knowledge, competence, and likely the clinical care provided to patients with NSCLC.

ES 03.03 Allied Health: The Missing Link in Comprehensive Cancer Care

ES 03.03 Allied Health: The Missing Link in Comprehensive Cancer Care

Lung cancer diagnosed by a metastatic lesion in the mandible

Introduction Lung cancer is the second most common cancer in the UK accounting for 13% of all new cases. It is the second most common cancer in both males and females. Lung (12.6%) is the second most common primary to metastasis to the jawbones preceded by breast (21.8%). Distant metastasis are present in the late stages of the disease. It is reported that the prognosis following presentation of oral metastasis is poor with the mean survival time 7.3 months. Bony metastases are rarely asymptomatic and in 2.3% of cases the bone metastasis is the initial presenting complaint as presented here. Case description 61-year-old female presented to AE the results indicated the lesion to be a metastatic deposit from adenocarcinoma of the lung. Results and conclusions Given the findings the patient was referred urgently to the lung cancer team who completed a contrast CT scan which identified a large right apical mass with areas of necrosis consistent with neoplastic disease. Borderline mediastinal and supraclavicular lymph nodes and possible suspicious lesions were identified in the left adrenal gland. Given these findings the tumour was staged T4 N2 M0 (N3M1b if supraclavicular node and adrenal lesion involved). The radiologist reporting was unaware of the suspected metastatic lesion in the mandible. Take-home message • The diagnosis of metastatic lesion may be difficult owing to their rarity and clinical presentation. • There is the potential for misdiagnosis as a benign lesion or odontogenic pathology. • Therefore a biopsy is essential especially in patients with a known previous history of malignancy. • Health professionals should be aware of the possible presence of jaw metastasis in patients with atypical presenting symptoms.

Resectable Clinical N2 Non–Small Cell Lung Cancer; What Is the Optimal Treatment Strategy? An Update by the British Thoracic Society Lung Cancer Specialist Advisory Group

Patients and clinicians are faced with uncertainty as to the optimal treatment strategy for potentially resectable NSCLC in which there is clinical evidence of involvement of the ipsilateral mediastinum. Randomized controlled trials and meta-analyses have failed to demonstrate superiority of one bimodality strategy over another (chemotherapy plus surgery versus chemotherapy plus radiotherapy). One trial of trimodality treatment with chemotherapy, radiotherapy, and surgery demonstrated an improvement in progression-free, but not overall, survival versus chemotherapy and radiotherapy. There are a number of limitations to the data in this complex and heterogenous patient group. No randomized controlled trial has specifically studied patients with single-station N2 disease versus multistation N2 disease. When discussing treatment for fit patients with potentially resectable cN2 NSCLC, lung cancer teams should consider trimodality treatment with chemotherapy, radiotherapy, and surgery or bimodality treatment with chemotherapy and either surgery or radiotherapy. We advocate that all patients see both a thoracic surgeon and the oncology team to discuss these different approaches.

92: Re-evaluation of the support worker within the lung cancer team

92: Re-evaluation of the support worker within the lung cancer team

Up-to date role of interventional pulmonology in the diagnosis and staging of non-small-cell lung cancer

Lung cancer treatment plans depend entirely on accurate diagnosis and staging. Recent advances in bronchoscopic technology have provided the interventional pulmonologist with elegant and effective sampling methods that have improved the chances to get both tissue diagnosis and thorough mediastinal staging. Among these techniques, particular attentions deserve navigational bronchoscopy and radial endobronchial ultrasound (r-EBUS) for the diagnosis of peripheral lung nodules, as well as endosonography (EBUS-TBNA, EUS/EUS-b-NA) for both the mediastinal lymph node staging and the approach to peribronchial/esophageal central lesions. The main role of the Interventional Pulmonologist in this setting is to apply these procedures based on a correct interpretation of clinical and radiographic findings, in order to maximize the chances to achieving the diagnostic and staging information needed by the multidisciplinary lung cancer team for the optimal management of each specific case.

Multidisciplinary Lung Cancer Meetings: Improving the practice of radiation oncology and facing future challenges

Clinical guidelines widely recognize the importance of multidisciplinary meetings (MDM) in the optimal care of lung cancer patients. The published literature suggest that dedicated Lung Cancer MDM lead to increased treatment utilization rates and improved survival outcomes for patients with lung cancer. For radiation oncologists, Lung Cancer MDM have been proven to support evidence-based practice and improve the utilization of radiotherapy. Lung Cancer MDM also allow for education and promotion of specialty radiotherapy services. The fast pace of modern medicine is also presenting new challenges for the multidisciplinary lung cancer team, and technological advances are likely to lead to new changes in the structure of traditional Lung Cancer MDM.

P90 Catch - Community Access To Ct Chest

Introduction Rates of lung cancer diagnosis for two week wait (2WW) referrals are although referrals are increasing. Many 2WW’s are potentially exposed to unnecessary anxiety as the referral requires the G. P. to inform the patient of the possibility of cancer. CATCH ( C ommunity A ccess T o CT Ch est) is a new protocol of care that has been developed by the Salford lung cancer team in collaboration with the Salford C. C. G. whereby abnormal low reports are communicated to G. P.s with instructions for them to request a CT scan, which is then fast tracked allowing rapid performance and reporting of the scan with appropriate advice to the GP. Methods A d-base was set up to capture the performance of CATCH from its introduction on 05.02.2014 to 05.07.2014. Demographic details were collected for dates of CXR, report, CT request, CT report, relevant outcomes and 2WW activity for same time (2011–2014). Participating patients were interviewed by telephone using a structured questionnaire (supported by a postal questionnaire for non-responders). Results 53 patients underwent an abnormal with advice to enter into the CATCH protocol and of these 7 bypassed CATCH having been referred directly into the 2WW system by their G. P.s. For the 46 patients completing CATCH, seven (15%) urgent 2WW referrals were recommended. In the remaining 39 patients, 28 required no follow up, 9 non-urgent referral to the chest clinic and 2 repeat community CXRs. Timelines for performance of CT scans were acceptable (see Table) and detected cancer in 5/46 (10.9%) and were normal in 8/46 (17.4%). 23–26 patients interviewed to date rated the service overall as either very good or excellent. During same points in 2011, 2012, 2013 and 2014 2WW numbers were 69, 84, 89 and 81 respectively. Conclusions Our provisional data support the role of CATCH as a new system of care for managing low risk CXR reports that might otherwise be referred into growing 2WW clinics. Thus far, the protocol moves at a rapid pace and has been well received by the patient (although we await the results of the postal survey in due course).

Impact of a specialist clinical cancer pharmacist at a multidisciplinary lung cancer clinic.

Medication misadventure contributes to unplanned hospital admissions. General practitioners (GPs) may lack experience in managing problems involving complex cancer-related medication. A previous survey explored the unmet needs of lung cancer outpatients and highlighted their desire for more medication information. Inpatient clinical pharmacy services positively impact on patient care. This study evaluated the effects of extending this service to outpatients. A specialist cancer pharmacist joined the lung cancer clinic team for 6 months. Patients completed assessments of their medication adherence and their satisfaction with the provision of medicine information (at baseline and repeated within 30 days of initial pharmacist review). Following review, a medication list and plan (detailing recommendations/interventions) were provided to patients and their health care providers. Interventions were categorized and graded according to risk avoided. Unplanned admissions and clinic attendance rates were compared with the previous year. GPs' opinion of the service was also evaluated. Forty-eight patients participated in the study. Medication adherence (P = 0.007) and patient satisfaction (P < 0.001) significantly improved. A total of 154 pharmacist interventions were made: 4.5% extreme risk and 43.5% high risk. The mean number of unplanned admissions and clinic attendances per patient decreased from 0.3 to 0.26 (P = 0.265) and from 3.32 to 2.98 (P = 0.004), respectively. Seventy-four percent of surveyed GPs found the service useful. Adding a specialist cancer pharmacist to the outpatient lung cancer team led to significant improvements in patient medication adherence. Both patients and GPs were highly satisfied with the service. Medication misadventure and clinic attendances were reduced.

A multicentre randomised controlled trial of reciprocal lung cancer peer review and supported quality improvement: results from the improving lung cancer outcomes project

Background:Results from the National Lung Cancer Audit demonstrate unexplained variation in outcomes. Peer review with supported quality improvement has been shown to reduce variation in other areas of health care but has not been formally tested in cancer multidisciplinary teams. The aim of the current study is to assess the impact of reciprocal peer-to-peer review visits with supported quality improvement and collaborative working on lung cancer process and outcome measures.Methods:English lung cancer teams were randomised to usual care or facilitated reciprocal peer review visits followed by 12 months of supported quality improvement. The primary outcome was change in the following national audit indicators; mulitdisciplinary team discussion, histological confirmation, active treatment, surgical resection, small-cell chemotherapy and specialist nurse review. Patient experience was measured using a new lung cancer patient questionnaire in the intervention group.Results:Thirty teams (31 trusts) entered the intervention group and 29 of these submitted a total of 67 quality improvement plans. Active treatment increased in the intervention group (n=31) by 5.2% compared with 1.2% in the control group (n=48, mean difference 4.1%, 95% CI −0.1 to 8.2%, P=0.055). The remaining audit indicators improved similarly in all groups. Mean patient experience scores in the intervention group did not change significantly during the study but a significant improvement was seen in the scores for the five teams with the worst baseline scores (0.86 to 0.22, P<0.001).Conclusions:Reciprocal peer review with supported quality improvement was feasible and effective in stimulating quality improvement activity but resulted in only modest improvements in lung cancer treatment rates and patient experience.

Treatment decisions and survival for people with small-cell lung cancer

Background:Chemotherapy improves survival for many patients with SCLC, and hence it is important to understand variations in practice and outcomes for this treatment strategy.Methods:We used the National Lung Cancer Audit and Hospital Episodes Statistics to determine the proportion of patients who received chemotherapy for SCLC, and assess the effects of patient and organisational factors on the odds of receiving chemotherapy and of completing four cycles. We calculated median survival and used Cox regression to determine factors that predicted survival.Results:Of 15 091 cases of SCLC, 70% received at least one cycle of chemotherapy. More deprived people were less likely to receive chemotherapy, but patients were more likely to receive chemotherapy, and to complete ⩾four cycles, if they were referred to the lung cancer team by their GP. Median survival for those treated with chemotherapy was 12.9 months for limited and 7.3 months for extensive stage disease.Conclusions:The Linked NLCA and HES data provide real-life measures of survival in people treated with chemotherapy and show how this is influenced by patient and tumour characteristics. These data show the characteristics of patients who are less likely to complete a full course of treatment, an adverse predictor of survival.

94 Lung nodule surveillance programme (LNSP) in a cancer unit: Lung cancer team experience from Bedford Hospital, UK

94 Lung nodule surveillance programme (LNSP) in a cancer unit: Lung cancer team experience from Bedford Hospital, UK

Method of biopsy and sample quality for genetic mutation testing in advanced non-small cell lung cancer in a community hospital.

271 Background: Mutated EGFR gene testing transformed the care of NSCLC. ASCO now recommends EGFR mutation testing for NSCLC (April 2011); however, no studies to assess quality of biopsy samples and adequacy for mutation testing have been done outside a trial setting. Methods: A retrospective chart review to identify patients diagnosed with NSCLC at a community hospital during 2010. A pathologist reviewed the quality of archivedbiopsy samples for histological diagnosis and adequacy for EGFR mutation testing based on ASCO criteria. Results: In 2010, 64 cases of NSCLC were diagnosed and 18 patients had definitive surgery, 46 did not. Histological subtypes: squamous - 28 (44%), adenocarcinoma - 23 (36%), bronchoalveolar - 3 (5%), adeno with mixed bronchoalveolar - 2 (3%), large cell - 3 (5%), and large cell neuroendocrine - 2 (3%). Staging: stage I, II, III, IV - 18 (28%), 2 (3%), 13 (20%), 23 (36%). Biopsy material: transbronchial needle biopsy in 23 (36%), CT-guided biopsy in 13 (20%), surgery in 18 (28%), other - 10 (15%). Specimen review: 3 samples (5%) were designated as large cell carcinoma without squamous or adeno specification. 46/64 (72%) were adequate for mutation analysis; 18 (28%) were not. Among adenoca., 19/28 (68%) were adequate samples, but 9 (32%) were not. Among the 46 patients who had advanced or metastatic disease, 28 (60%) had sufficient samples, 18 (40%) did not. Among advanced adenoca. patients, the proportion without adequate sample was 9/18 (50%). Route of biopsy: 4/23 transbronchial biopsies (17%), 8/13 CT-guided biopsies (62%) and 6/10 from other sites (60%) were inadequate (p = 0.01). Conclusions: Nearly one-third of all NSCLC cases, including half of advanced adenoca., yielded poor quality specimens from the first biopsy for EGFR mutation analysis. 5% of samples lacked definitive histology. CT-guided transthoracic biopsies were at least twice as likely to yield poorer quality specimens compared to transbronchial biopsies. Poor quality tumor sampling may preclude mutation testing thus denying beneficial and less toxic therapy. Quality of tumor specimens needs to be improved in the future by the development of appropriate strategies by multidisciplinary lung cancer teams.

S90 The National Lung Cancer Audit – No Evidence of a “Seven-Year Itch”

IntroductionThe National Lung Cancer Audit, now in its7th year, is run jointly by the Royal College of Physicians and The Information Centre for health and social care, and is commissioned...