On the 3rd November 2015 I was lucky enough to be invited by the British Lung foundation to represent the Association of Respiratory Nurse Specialists (ARNS) to hear about their key recommendations from the working group to tackle the poor lung cancer patient outcomes in the UK.
As a specialist respiratory nurse it is important that this work is recognised, promoted and supported to ensure that all lung diseases are highlighted, whilst I am not a Lung cancer CNS it’s important that respiratory care is to recognise and remains in the spotlight within parliament to improve outcomes for all our patients.
What I was unaware of, before I attended the launch was that, compared to the European average, cancer survival in England is low. Lung cancer is the UK’s biggest cancer killer, accounting for more than 1 in 5 of all cancer deaths. Dr Penny Woods, Chief Executive of the British Lung Foundation states that “despite claiming so many lives, lung cancer has not been given the prioritisation of other common cancers such as breast and prostate, something which is necessary if we are to tackle to poor patient outcomes that make the UK one of the worst places to have lung cancer in Europe, if not the world”. Dr Tom Newsom-Davis, Chair of the Expert Lung Cancer Working Group, and Jane Ellison MP, Parliamentary Under Secretary of State for Public Health were among those presenting the recommendations and why they are essential.
In 2013, around 34% of all lung cancer patients were diagnosed via emergency routes, compared with 20% of other cancers. This was surprising to me as someone who does not work in this field, I have always assumed that patients were identified and treated quickly and appropriately. This is not what is happening. Many patients are going to their GPs too late when their persistent cough is troubling them. The GPs are finding it hard to communicate with secondary care and to also get access to CT scans.
The key recommendations aimed to improve this are:
Recommendation 1. Funding for a National campaign (such as Be Clear on Cancer, Detect Cancer Early or Be Cancer Aware) be maintained or increased, in order to raise awareness of the signs and symptoms of lung cancer
Recommendation 2. A commitment be made to rapid adoption of a targeted evidenced-based lung cancer screening programme, as deemed effective by the UK National Screening Committee, in order to reduce the number of lung cancer patients diagnosed late and via emergency routes.
Recommendation 3. Lung cancer risk assessment/clinical decision support tools be tested and the most effective be made available in all primary care practices. Appropriate support be provided to enable GPs to utilise these tools at practice level and, where possible, a scaled-up version should be made available at CCG level.
Recommendation 4. If proven effective and feasible, rapid access outpatient pathways should be introduced to prevent unnecessary emergency admissions.
Recommendation 5. A timed pathway for patients with suspected lung cancer admitted as an emergency, from time of initial presentation. This would include:
• Seeing a member of the Acute Oncology Service of Lung Team within 24 hours
• A CT scan conducted within 48 hours
• Review by the lung multi-disciplinary team (MDT) within a week
• Being seen by a member of the lung MDT within a week
Recommendation 6. GPs be able to make direct access referrals for CT scans for patients with suspected lung cancer
Recommendation 7. All chest X-Rays and CT scans be formally reported within four days. The individual requesting the x-ray must acknowledge and act upon the result. Local mechanisms should be in place to ensure scans which suggest a possible diagnosis of lung cancer trigger referral to a Specialist Rapid Access Lung Cancer Clinic.
Recommendation 8. Direct telephone or email access between GP practise and secondary care consultants to speed discussion about high risk cases.
Recommendation 9. Centralised systems be set up, either at GP federation, CCG or regional levels, in order to ensure data can be shared.
Recommendation 10. A Clinical Nurse Specialist (CNS) be available to all patients undergoing investigation for suspected lung cancer
Recommendation 11. All patients diagnosed in an emergency setting be seen within 24 hours by an Acute Oncology Nurse, who then acts as the patients key worker until they are safely handed over to the appropriate CNS.
As Dr Penny Woods states, ‘it is time for lung cancer patients to be prioritised and for the stigma associate with the disease to be overcome’.
Improved communication, access to services and referral pathways and improved links to Clinical Nurse Specialists will go a long way to improving the outcomes for Lung cancer patients in the UK.
As a specialist nurse I found this key recommendation to be the most powerful for me. We know that CNS’s make a significant difference to the care and lives of our patients and it was great to see that recognised in this document and that the need for more specialist nurses in this area is vital.