Rapid Access Lung Cancer Clinic Research Articles

The impact of the COVID-19 pandemic on the performance of the Rapid Access Lung Cancer Clinic.

The Rapid Access Lung Cancer Clinic (RALC) experienced fewer referrals during the COVID-19 pandemic in Ireland. Our aim was to determine the impact of the pandemic on the key performance indicators (KPIs) of the Cork University Hospital (CUH) RALC, using a retrospective chart review of the referrals and attendances. The medical charts of patients referred to CUH-RALC from 03/2019 to 02/2020 (period I), and from 03/2020 to 02/2021 (period II) were reviewed. Performance of the RALC was determined based on average wait time from referral to 1] acquisition of the first CT scan, 2] consultation, and 3] receiving a cancer diagnosis, and compared between periods I and II. Average monthly referrals (57.3 vs 42.1, p = 0.0078) and RALC reviews (24.3 vs 22, p = 0.0310) were lower in period II compared to period I. However, no difference was seen in the length of time from referral to review at RALC or time to receive cancer diagnosis. There were shorter wait times from referral to CT scan (11.2 vs. 8.7 days, p = 0.0011) and to surgery (109.0 vs 79.3 days, p = 0.0236) in period II. The COVID-19 pandemic had minimal impact on the performance of RALC at our institution. Fewer referrals to RALC in period II may relate to hesitancy in attending general practitioner (GP) and/or GPs raising the thresholds for referrals to RALC during the early lockdown period of the pandemic. A national evaluation will be required to fully determine the impact of this pandemic on lung cancer in Ireland.

29 Reorganising weekly rapid access lung cancer clinic into daily could help to implement best practice timed lung cancer pathway and meet faster diagnosis standard

29 Reorganising weekly rapid access lung cancer clinic into daily could help to implement best practice timed lung cancer pathway and meet faster diagnosis standard

52 Patient outcome at rapid access lung cancer clinic

52 Patient outcome at rapid access lung cancer clinic

393O - Timeliness of lung cancer treatment utilizing the rapid access lung cancer clinic in a regional Australian Hospital

BackgroundPatients in remote and rural areas of Australia are disadvantaged in receiving and accessing healthcare. Lung cancer incidence and mortality is increased in remote areas compared to metropolitan regions. The rapid access lung cancer (RALC) clinic was established in 2017 in order to optimize timeliness to treatment and improve patient outcomes. MethodsRetrospective audit of all patients diagnosed with lung cancer in 2018 within the Ballarat Health service and was stratified according to stage of cancer. Mean timeframes were derived from the Australian optimal care pathway (OCP) for people with lung cancer and analysed using descriptive statistics. ResultsTotal of 84 patients were diagnosed with lung cancer in 2018, with 72% being seen in the RALC clinic. Overall 77.3% met the OCP timeframe of referral to treatment in less than 42 days as compared to only 48.5% in 2015-2016. Stage I/II, III and stage IV patients had mean referral to treatment intervals of 53, 40 and 22 days respectively. Stage IV RALC patients compared to general clinic patients, proceeded to treatment faster after diagnosis (7 days vs 28 days, p = 0.04) and were presented at MDT more frequently (44.5% vs 13.5%). In Stage I/II and stage III patients who had delays from diagnosis to treatment, main reasons were waiting times for surgery, radiotherapy and further diagnostic test. Limitations of a regional centre include having to refer externally for both EBUS and complex surgery offered only in metropolitan hospitals. ConclusionsRALC clinics have reduced time to definitive treatment. Early stage patients require more complex work up and multi-modality treatment, so have a longer time to first treatment over advanced stage patients. Despite the obstacles of a regional centre, the time to treatment were shorter that of metropolitan public hospitals. Longer follow-up will determine if improved timeliness will lead to better patient outcomes. Legal entity responsible for the studyBallarat Health Service. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Radiation Therapy Near End of Life in a Rapid Access Lung Cancer Clinic Compared to Standard Practice

Radiation Therapy Near End of Life in a Rapid Access Lung Cancer Clinic Compared to Standard Practice

P2.11-27 A Rapid Access Lung Cancer Clinic Reduces Variation in Lung Cancer Diagnostic and Treatment Services.

P2.11-27 A Rapid Access Lung Cancer Clinic Reduces Variation in Lung Cancer Diagnostic and Treatment Services.

Bronchoscopy in the investigation of outpatients with hemoptysis at a lung cancer clinic.

In the investigation of lung cancer, current practice in many healthcare systems would support bronchoscopy regardless of CT findings in patients with hemoptysis. We sought to identify the cause, the diagnostic yield of CT and bronchoscopy and the requirement for bronchoscopy in at risk patients with hemoptysis with a normal CT scan through our rapid access lung cancer clinic (RALC). Initially, a chart review was performed on all patients with hemoptysis (2011-2012) and thereafter a prospective analysis was performed (2013-2016). Our analysis represents the largest study to date in outpatients with hemoptysis. In our retrospective study, 155 patients reported hemoptysis. Causes were lower respiratory tract infections (RTIs) (47%) and lung cancer (16%). Our prospective study included 182 patients. The causes of hemoptysis were RTIs (50%) and lung cancer (18%). There were no false negative CT-scans for lung cancer. 47/57 present with lung cancer underwent bronchoscopy and 43/47 were positive for lung cancer (92%). Patients with hemoptysis and lung cancer have a higher stage of malignancy with a predominance of squamous cell lung carcinoma. Smoking status, the duration of hemoptysis or description of hemoptysis were not predictive of lung cancer however lung cancer was not identified in patients age <50. One sixth of patients presenting with hemoptysis to our lung cancer clinic had lung cancer. No patient identified with cancer related haemoptysis had a CT negative for lung cancer and a combination of bronchoscopy plus endobronchial ultrasound trans-bronchial needle aspiration (EBUS-TBNA) in those patients with a CT suspicious of lung cancer is 92% sensitive for lung cancer causing hemoptysis.

33 Patient reported experience measures in improving rapid access lung cancer clinic holistic care outcomes

33 Patient reported experience measures in improving rapid access lung cancer clinic holistic care outcomes

Association of sarcopenia and observed physical performance with attainment of multidisciplinary team planned treatment in non-small cell lung cancer: an observational study protocol.

BackgroundNon-small cell lung cancer (NSCLC) frequently presents in advanced stages. A significant proportion of those with reportedly good ECOG performance status (PS) fail to receive planned multidisciplinary team (MDT) treatment, often for functional reasons, but an objective decline in physical performance is not well described. Sarcopenia, or loss of muscle mass, is an integral part of cancer cachexia. However, changes in both muscle mass and physical performance may predate clinically overt cachexia, and may be present even with normal body mass index. Physical fitness for treatment is currently subjectively assessed by means of the PS score, which may be inadequate in predicting tolerance to treatment. This study aims to evaluate whether measuring physical performance and muscle mass at baseline in NSCLC patients, in addition to PS score, is able to predict commencement and successful completion of MDT-planned treatment.Methods/designThis is a prospective, single-centre exploratory study of NSCLC patients attending a Rapid Access Lung Cancer clinic. Baseline data collected are (methods in brackets): physical performance (Short Physical Performance Battery), muscle mass (bioelectrical impedance ± dual energy x-ray absorptiometry), patient and physician-assessed PS (ECOG and Karnofsky), nutritional status and presence of cachexia. Longitudinal data consists of receipt and completion of MDT treatment plan. The primary outcome measure is commencement of MDT-planned treatment, and important secondary outcomes include successful completion of treatment, length of stay in surgical patients, and risk of chemotherapy- and radiotherapy-related side effects.DiscussionA more comprehensive assessment of phenotype, particularly with regards to physical performance and muscle mass, will provide additional discriminatory information of patients’ fitness for treatment. If positive, this study has the potential to identify targets for early intervention in those who are at risk of deterioration. This will subsequently enable optimisation of performance of patients with NSCLC, in anticipation of systemic treatment.

The Utility of Bronchoscopy Following Computed Tomography of Thorax in the Assessment of Hemoptysis Presenting to a Rapid Access Lung Cancer Clinic

The Utility of Bronchoscopy Following Computed Tomography of Thorax in the Assessment of Hemoptysis Presenting to a Rapid Access Lung Cancer Clinic

An unusual cause of haemoptysis in a smoker

A 33-year-old Caucasian male smoker presented to our rapid access lung cancer clinic with a single episode of moderate haemoptysis and no other respiratory or systemic symptoms. There was no...

1444 - Integrated Palliative and Medical Oncology Care for Patients with Small Cell Lung Cancer

ABSTRACT Introduction Conventionally, palliative care services have been viewed as a terminal line of management when primary treatment is unsuccessful. Recent studies have shown that integration of palliative care medicine with medical oncology care substantially increases quality of life and survival duration in patients with non-small cell lung cancer1. This study was carried out in the Beaumont Hospital Cancer Centre highlighting the patterns of palliative care and medical oncology interventions in the management of patients with small cell lung cancer (SCLC). Methods Information from patient records, intranetwork hospital databases, pathological reports, pharmaceutical entries and clinical notes of all patients diagnosed with SCLC through the Rapid Access Lung Cancer Clinic (RALCC) between 2008 to 2011 was compiled into a database. Results Between 2008 to 2011, 58 patients presented to the RALCC and were diagnosed with small cell lung cancer. From this total amount, 50 patients were actively managed at our multidisciplinary centre. Of the 50 patients, 31 had extensive disease while 19 had limited disease. The median survival duration for actively treated patients with limited and extensive disease was 13 (range; 4 – 38) and 5.5 (range; 0.5 – 17) months respectively. 46 (92%) patients received chemotherapy with the most common regimen being Etoposide and Carboplatin combination. The other 4 (8%) patients did not receive chemotherapy due to various reasons mainly; patient's preference, rapid deterioration and low performance status. 40 (80%) patients of the total cohort received palliative care services. The remaining 10 (20%) patients did not receive palliative treatment as the disease was well controlled by chemotherapeutic interventions. All patients who did not receive medical oncology services benefitted from palliative care treatments. Conclusion This study revealed that almost all patients managed with medical oncology interventions had palliative care involvement, demonstrating significant integration between the disciplines. 1Temel et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med. 2010;363:733-42. Disclosure All authors have declared no conflicts of interest.

P-236 ‘One-stop’ rapid access lung cancer clinic: The patients perspective

P-236 ‘One-stop’ rapid access lung cancer clinic: The patients perspective

P-696 Strategies employed by patients to cope with the stress of a rapid access lung cancer clinic

P-696 Strategies employed by patients to cope with the stress of a rapid access lung cancer clinic