- Email: [email protected]
108 Patient satisfaction survey for one stop lung cancer clinic
Poster abstracts, 11th Annual British Thoracic Oncology Group Conference, 2013: Networks & Pathways Table 1. Prevalence of symptoms and other needs identified at first PM appointment Symptom
Prevalence (%)
Pain Dyspnoea Appetite loss Bowel problems Nausea/vomiting Fatigue Mouth problems Cough Sleep disturbance Other physical symptom Psychological distress Social difficulties Family difficulties Information need Advance Care Planning need
72 51 35 32 29 28 19 17 12 29 54 40 25 45 41
Background: Lung cancer, the second most common cancer in the UK, accounts for 13% of the new cases. The survival rate has improved over the last decade, but remains below 10% [1]. There are various routes to diagnosis of a cancer, the commonest being a two week wait when an urgent referral is made with a suspicion of cancer. However, about 38% of lung cancer patients present to the hospital via A&E or EAU which is associated with a poor survival outcome [2]. Method: We conducted a retrospective analysis of patients who had an emergency presentation to our hospital between June 2012 and Aug 2012 and were subsequently diagnosed with a thoracic malignancy. Total cases (30) Males (15) Females (15) Age Range 51-93 years
Histology (23)
SCLC (3) Chemotherapy (3)
Adenocarcinoma (8) BSC (1) Chemotherapy (4) Radiotherapy (1) Surgery (2)
NET (3) BSC (1) Chemotherapy (1) Surgery (1)
No Histology (7)
Squamous Cell (8) BSC (2) Radiotherapy (3) Chemotherapy (1) Surgery (2)
NSCLC NOS (1) Surgery (1)
85 years and the majority presented via A&E. Figure 1 summarises the treatment outcomes. Of the 23 patients, 4 (17%) received Best Supportive Care (BSC). 6 (26%) had radical surgery. Conclusion: In lung cancer, stage is a key determinant of survival, which in turn depends on how early the tumour is discovered. Most patients present with respiratory symptoms and/or symptoms referable to the patterns of metastatic dissemination. Our study demonstrated that a significant proportion of lung cancer patients presented as an emergency to hospital. The majority of them received cancer directed therapies. However, elderly patients and those with poor PS were more likely to be offered BSC. There is substantial potential for improvement in early diagnosis with discernment of the family physician remaining an important factor. The findings of our study could help guide early diagnosis initiatives and encompass educational cancer awareness interventions for healthcare professionals. Reference(s) [1] www.cancerresearchuk.org/cancer-help/type/lung-cancer/ treatment/statistics-and-outlook-for-lung-cancer#outcome [2] www.ncin.org.uk/publications/data_briefings/ routes_to_diagnosis
106 Initial hospital presentation and outcome in patients diagnosed with thoracic malignancy N. Murukesh *, L. Dunphy, L. Skinner, A. Morgan, D.R. Ferry. The Royal Wolverhampton NHS Trust; New Cross Hospital, Wolverhampton; United Kingdom
Adenocarcinoma (8) Squamous Cell (8) SCLC (3) NSCLC NOS (1)
S37
107 Emergency admissions of lung cancer patients to a West Midlands hospital: causes and outcomes M. Palethorpe1 *, B. Rickett1 , J. Thompson1 , F. Marti1 . 1 Department of Medical Oncology, Birmingham Heartlands Hospital, UK Introduction: Lung cancer is the second commonest malignancy and generates the highest number of cancer emergency bed days per year amongst all the solid tumours in the UK. Patients admitted as an emergency can present with a variety of problems, not always related to either the lung cancer or its treatment. In the era of acute oncology, we were interested in reviewing the causes and outcomes for these admissions within our trust. Methods: The 30 most recent emergency admissions of lung cancer patients were identified using our emergency admissions flagging system. Records were obtained and relevant data extracted using a predefined data collection tool. Results: The median patient age of patients was 69 years. The majority of patients (93%) were admitted through A&E and only 7% were referred by their GP. In 33% of patients, the admissions were a result of general medical/surgical problems and unrelated to their cancer. Of those admissions related to cancer, 13% were due to complications of treatment, 24% were due to disease progression but not a consequence and 30% were related to the cancer of progressive disease. Following admission, 77% of patients were discharged home, 10% were admitted to the hospice and the remaining 13% died during the acute episode. Conclusions: One third of the admissions registered during this period were a direct consequence of the cancer, but not of disease progression, suggesting that some of these could be avoided with adequate patient education, community nursing/medical support and pre-planned admissions for procedures (e.g. pleural aspiration). Admissions related to treatment complications or disease progression remain a challenge and these are the areas where acute oncology services are expected to make the biggest contribution towards management and length of stay.
BSC
Figure 1.
Results: Thirty patients were identified of which 8 (27%) presented to the A&E and 22 (73%) were referred to EAU. 23 (77%) had a diagnostic intervention. Poor PS and co-morbidities made histology unobtainable in 7 (23%) cases. The median age for this group was
108 Patient satisfaction survey for one stop lung cancer clinic T. Gupta *, P. Anyadi, E. Dockree. Lister Hospital of E&N herts NHS Trust, UK Introduction: Lung cancer is a common cancer. The patients have experiences that can help shape the care pathway provided for future patients. The aim of this project was to analyse and compare the patient satisfaction from two different patient pathways those
S38
Poster abstracts, 11th Annual British Thoracic Oncology Group Conference, 2013: Networks & Pathways
presented through a one-stop lung cancer clinic and those presented as formal outpatients in a lung cancer clinic. Methods: Patients with confirmed lung cancer, from both groups were sent out satisfaction surveys through the post. At the Lister Hospital, one-stop lung cancer clinics have been offered as well as usual cancer clinics where a patient consults the doctor first and all other tests are scheduled for a later date. At a one-stop clinic, all the necessary tests (CT scan, bronchoscopy, blood test) required to diagnose are carried out on the same day as the patient meets their doctor. Results: The survey asked the patients to rate their experience on a scale of one to five, one being the worst and five being the best. The survey form and cover letter sent out to the 26 patients. 75% of patients feed back. The results showed that although patient satisfaction was extremely high for patients from both groups, those through a one-stop clinic scored higher satisfaction for their experience of being tested and diagnosed in hospital. The one-stop group had a mean satisfaction score of 34 of their experience of being diagnosed, compared to 30 for the ‘general’ clinic group. Conclusion: This survey shows that the concept of a one stop lung cancer clinic is appreciated by the patients as it does shorten the ‘patient journey’ and patients appreciate this greatly. From these results we can also suggest that other hospitals that don’t yet offer this service should consider providing the one-stop lung cancer clinic service. 109 Standards of lung cancer management in a South East England trust M.Z. Montefort *, A.J. Leonard. East Sussex Healthcare NHS Trust, UK Introduction: Lung cancer treatment continues to advance with national targets continuing to rise, making audit increasingly important. We present the data collected for LUCADA at the East Sussex Healthcare Trust in 2011. Methods: The data collected at the two hospitals making up the Conquest Hospital Hastings (CQ) and Eastbourne District trust General Hospital (EDGH) was analysed for four quality indicators: % histological confirmation rate; % having active treatment; % of non-small cell carcinoma cases undergoing surgical resection; and % of small cell carcinoma (SCLC) patients receiving chemotherapy. The data from each hospital was compared to the other, to data from previous years (presented at last year’s conference) and to national averages. Results: 131 cases presented at CQ and 135 at EDGH. Histology was obtained in 81.7% of cases at CQ and 81.5% at EDGH, above the national average (75%). Active treatment was given in 59.5% the Trust average was 53.4% an at CQ and 47.4% at EDGH improvement from the year before but below the national average. Resection rate was 17.4% at CQ and 8.2% at EDGH. Though there was a big difference between the two sites, the Trust average (12.8%) improved but is still below national average. The percentage of SCLC patients receiving chemotherapy was 56.3% at CQ and 69.2% at EDGH. The Trust average of 62.1% was below national average and has also dropped from last year. Conclusions: Unfortunately although acquisition of histology is good and continues to improve, we are still lacking in terms of treatment standards, compared to national averages. On a Trust level compared to last year, our active treatment and resection rates have improved, but SCLC treatment has decreased. Hopefully 2012 data will show improvements that we hope to achieve after combining the MDMs at the two sites and including a thoracic surgeon.
110 Follow up after resection of lung cancer: a survey of surgical practice in the UK and Ireland A.J. Greenwood1 *, D.G. West1 . 1 Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, UK Introduction: National guidelines recommend follow up after lung cancer resection, but are not prescriptive about frequency or use of imaging. Recently, interest in CT scanning has increased, based on positive studies in primary screening, and its use in follow up of other malignancies. This survey aims to define current British and Irish practice. Methods: SCTS members who identified themselves as “thoracic” or “cardiothoracic” surgeons were contacted and invited to complete an online survey tool. Results: 48 SCTS consultant members are registered as thoracic surgeons, 66 as cardiothoracic surgeons. 58 responses were received, 46 from consultant members. All respondents routinely followed up patients in secondary care. 15 (25.9%) of respondents followed up beyond 5 years. The commonest protocol involves 9 clinic appointments per patient, equating to 47,385 planned appointments annually in the UK and Ireland (based on 2009/10 SCTS activity data). Parameter Which clinical service performs follow up? Surgery Joint care Respiratory medicine Oncology Primary care Radiology CT scans used routinely Who sees patients? Nurse specialists (independently) Nurse specialists (with medical staff) Medical staff alone Median frequency of appointments in months (IQR) Year 1 Year 2 Year 3 Year 4 Year 5
28 (48%) 15 (26%) 14 (24%) 1 (2%) 0 (0%) 13 (22%) 9 (16%) 20 (34%) 28 (50%) 3 (3 6) 6 (6 12) 12 (12 12) 12 (12 12) 12 (12 12)
Conclusions: Despite a lack of strong evidence or strict guidance, protocols are remarkably consistent, with reducing appointments over 5 years the commonest pattern. Nurse follow-up remains limited despite national guidelines. CT scanning is unusual. Lung cancer follow up uses significant resources. The benefits, if any, need to be established. Its ability to detect subclinical recurrence suitable for radical or palliative therapy needs quantified, as does any psychological or functional benefit. CT scans have shown survival benefit in primary screening, and warrant study as a follow up tool. 111 A referral pro-forma can reduce time from surgical resection to adjuvant chemotherapy for NSCLC patients S. Sriskandarajah1 *, K. Hewitt1 , R. Peck1 , P. Bishop, R. Califano1 , Y. Summers1 , R. Shah1 , P. Taylor1 . 1 University Hospitals of South Manchester NHS Trust, UK Introduction: Adjuvant chemotherapy (AC) reduces relapse following resection of stage II and III NSCLC, with possible benefit in larger (4 cm) stage IB tumours. Positive trials of AC started chemotherapy
Prevalence (%)
Pain Dyspnoea Appetite loss Bowel problems Nausea/vomiting Fatigue Mouth problems Cough Sleep disturbance Other physical symptom Psychological distress Social difficulties Family difficulties Information need Advance Care Planning need
72 51 35 32 29 28 19 17 12 29 54 40 25 45 41
Background: Lung cancer, the second most common cancer in the UK, accounts for 13% of the new cases. The survival rate has improved over the last decade, but remains below 10% [1]. There are various routes to diagnosis of a cancer, the commonest being a two week wait when an urgent referral is made with a suspicion of cancer. However, about 38% of lung cancer patients present to the hospital via A&E or EAU which is associated with a poor survival outcome [2]. Method: We conducted a retrospective analysis of patients who had an emergency presentation to our hospital between June 2012 and Aug 2012 and were subsequently diagnosed with a thoracic malignancy. Total cases (30) Males (15) Females (15) Age Range 51-93 years
Histology (23)
SCLC (3) Chemotherapy (3)
Adenocarcinoma (8) BSC (1) Chemotherapy (4) Radiotherapy (1) Surgery (2)
NET (3) BSC (1) Chemotherapy (1) Surgery (1)
No Histology (7)
Squamous Cell (8) BSC (2) Radiotherapy (3) Chemotherapy (1) Surgery (2)
NSCLC NOS (1) Surgery (1)
85 years and the majority presented via A&E. Figure 1 summarises the treatment outcomes. Of the 23 patients, 4 (17%) received Best Supportive Care (BSC). 6 (26%) had radical surgery. Conclusion: In lung cancer, stage is a key determinant of survival, which in turn depends on how early the tumour is discovered. Most patients present with respiratory symptoms and/or symptoms referable to the patterns of metastatic dissemination. Our study demonstrated that a significant proportion of lung cancer patients presented as an emergency to hospital. The majority of them received cancer directed therapies. However, elderly patients and those with poor PS were more likely to be offered BSC. There is substantial potential for improvement in early diagnosis with discernment of the family physician remaining an important factor. The findings of our study could help guide early diagnosis initiatives and encompass educational cancer awareness interventions for healthcare professionals. Reference(s) [1] www.cancerresearchuk.org/cancer-help/type/lung-cancer/ treatment/statistics-and-outlook-for-lung-cancer#outcome [2] www.ncin.org.uk/publications/data_briefings/ routes_to_diagnosis
106 Initial hospital presentation and outcome in patients diagnosed with thoracic malignancy N. Murukesh *, L. Dunphy, L. Skinner, A. Morgan, D.R. Ferry. The Royal Wolverhampton NHS Trust; New Cross Hospital, Wolverhampton; United Kingdom
Adenocarcinoma (8) Squamous Cell (8) SCLC (3) NSCLC NOS (1)
S37
107 Emergency admissions of lung cancer patients to a West Midlands hospital: causes and outcomes M. Palethorpe1 *, B. Rickett1 , J. Thompson1 , F. Marti1 . 1 Department of Medical Oncology, Birmingham Heartlands Hospital, UK Introduction: Lung cancer is the second commonest malignancy and generates the highest number of cancer emergency bed days per year amongst all the solid tumours in the UK. Patients admitted as an emergency can present with a variety of problems, not always related to either the lung cancer or its treatment. In the era of acute oncology, we were interested in reviewing the causes and outcomes for these admissions within our trust. Methods: The 30 most recent emergency admissions of lung cancer patients were identified using our emergency admissions flagging system. Records were obtained and relevant data extracted using a predefined data collection tool. Results: The median patient age of patients was 69 years. The majority of patients (93%) were admitted through A&E and only 7% were referred by their GP. In 33% of patients, the admissions were a result of general medical/surgical problems and unrelated to their cancer. Of those admissions related to cancer, 13% were due to complications of treatment, 24% were due to disease progression but not a consequence and 30% were related to the cancer of progressive disease. Following admission, 77% of patients were discharged home, 10% were admitted to the hospice and the remaining 13% died during the acute episode. Conclusions: One third of the admissions registered during this period were a direct consequence of the cancer, but not of disease progression, suggesting that some of these could be avoided with adequate patient education, community nursing/medical support and pre-planned admissions for procedures (e.g. pleural aspiration). Admissions related to treatment complications or disease progression remain a challenge and these are the areas where acute oncology services are expected to make the biggest contribution towards management and length of stay.
BSC
Figure 1.
Results: Thirty patients were identified of which 8 (27%) presented to the A&E and 22 (73%) were referred to EAU. 23 (77%) had a diagnostic intervention. Poor PS and co-morbidities made histology unobtainable in 7 (23%) cases. The median age for this group was
108 Patient satisfaction survey for one stop lung cancer clinic T. Gupta *, P. Anyadi, E. Dockree. Lister Hospital of E&N herts NHS Trust, UK Introduction: Lung cancer is a common cancer. The patients have experiences that can help shape the care pathway provided for future patients. The aim of this project was to analyse and compare the patient satisfaction from two different patient pathways those
S38
Poster abstracts, 11th Annual British Thoracic Oncology Group Conference, 2013: Networks & Pathways
presented through a one-stop lung cancer clinic and those presented as formal outpatients in a lung cancer clinic. Methods: Patients with confirmed lung cancer, from both groups were sent out satisfaction surveys through the post. At the Lister Hospital, one-stop lung cancer clinics have been offered as well as usual cancer clinics where a patient consults the doctor first and all other tests are scheduled for a later date. At a one-stop clinic, all the necessary tests (CT scan, bronchoscopy, blood test) required to diagnose are carried out on the same day as the patient meets their doctor. Results: The survey asked the patients to rate their experience on a scale of one to five, one being the worst and five being the best. The survey form and cover letter sent out to the 26 patients. 75% of patients feed back. The results showed that although patient satisfaction was extremely high for patients from both groups, those through a one-stop clinic scored higher satisfaction for their experience of being tested and diagnosed in hospital. The one-stop group had a mean satisfaction score of 34 of their experience of being diagnosed, compared to 30 for the ‘general’ clinic group. Conclusion: This survey shows that the concept of a one stop lung cancer clinic is appreciated by the patients as it does shorten the ‘patient journey’ and patients appreciate this greatly. From these results we can also suggest that other hospitals that don’t yet offer this service should consider providing the one-stop lung cancer clinic service. 109 Standards of lung cancer management in a South East England trust M.Z. Montefort *, A.J. Leonard. East Sussex Healthcare NHS Trust, UK Introduction: Lung cancer treatment continues to advance with national targets continuing to rise, making audit increasingly important. We present the data collected for LUCADA at the East Sussex Healthcare Trust in 2011. Methods: The data collected at the two hospitals making up the Conquest Hospital Hastings (CQ) and Eastbourne District trust General Hospital (EDGH) was analysed for four quality indicators: % histological confirmation rate; % having active treatment; % of non-small cell carcinoma cases undergoing surgical resection; and % of small cell carcinoma (SCLC) patients receiving chemotherapy. The data from each hospital was compared to the other, to data from previous years (presented at last year’s conference) and to national averages. Results: 131 cases presented at CQ and 135 at EDGH. Histology was obtained in 81.7% of cases at CQ and 81.5% at EDGH, above the national average (75%). Active treatment was given in 59.5% the Trust average was 53.4% an at CQ and 47.4% at EDGH improvement from the year before but below the national average. Resection rate was 17.4% at CQ and 8.2% at EDGH. Though there was a big difference between the two sites, the Trust average (12.8%) improved but is still below national average. The percentage of SCLC patients receiving chemotherapy was 56.3% at CQ and 69.2% at EDGH. The Trust average of 62.1% was below national average and has also dropped from last year. Conclusions: Unfortunately although acquisition of histology is good and continues to improve, we are still lacking in terms of treatment standards, compared to national averages. On a Trust level compared to last year, our active treatment and resection rates have improved, but SCLC treatment has decreased. Hopefully 2012 data will show improvements that we hope to achieve after combining the MDMs at the two sites and including a thoracic surgeon.
110 Follow up after resection of lung cancer: a survey of surgical practice in the UK and Ireland A.J. Greenwood1 *, D.G. West1 . 1 Department of Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, UK Introduction: National guidelines recommend follow up after lung cancer resection, but are not prescriptive about frequency or use of imaging. Recently, interest in CT scanning has increased, based on positive studies in primary screening, and its use in follow up of other malignancies. This survey aims to define current British and Irish practice. Methods: SCTS members who identified themselves as “thoracic” or “cardiothoracic” surgeons were contacted and invited to complete an online survey tool. Results: 48 SCTS consultant members are registered as thoracic surgeons, 66 as cardiothoracic surgeons. 58 responses were received, 46 from consultant members. All respondents routinely followed up patients in secondary care. 15 (25.9%) of respondents followed up beyond 5 years. The commonest protocol involves 9 clinic appointments per patient, equating to 47,385 planned appointments annually in the UK and Ireland (based on 2009/10 SCTS activity data). Parameter Which clinical service performs follow up? Surgery Joint care Respiratory medicine Oncology Primary care Radiology CT scans used routinely Who sees patients? Nurse specialists (independently) Nurse specialists (with medical staff) Medical staff alone Median frequency of appointments in months (IQR) Year 1 Year 2 Year 3 Year 4 Year 5
28 (48%) 15 (26%) 14 (24%) 1 (2%) 0 (0%) 13 (22%) 9 (16%) 20 (34%) 28 (50%) 3 (3 6) 6 (6 12) 12 (12 12) 12 (12 12) 12 (12 12)
Conclusions: Despite a lack of strong evidence or strict guidance, protocols are remarkably consistent, with reducing appointments over 5 years the commonest pattern. Nurse follow-up remains limited despite national guidelines. CT scanning is unusual. Lung cancer follow up uses significant resources. The benefits, if any, need to be established. Its ability to detect subclinical recurrence suitable for radical or palliative therapy needs quantified, as does any psychological or functional benefit. CT scans have shown survival benefit in primary screening, and warrant study as a follow up tool. 111 A referral pro-forma can reduce time from surgical resection to adjuvant chemotherapy for NSCLC patients S. Sriskandarajah1 *, K. Hewitt1 , R. Peck1 , P. Bishop, R. Califano1 , Y. Summers1 , R. Shah1 , P. Taylor1 . 1 University Hospitals of South Manchester NHS Trust, UK Introduction: Adjuvant chemotherapy (AC) reduces relapse following resection of stage II and III NSCLC, with possible benefit in larger (4 cm) stage IB tumours. Positive trials of AC started chemotherapy