Prof Kwun Fong
Employing more specialist lung cancer nurses is key to improving access to treatment and reducing clinical nihilism, according to a blueprint report for reform released by Lung Foundation Australia (LFA).
The report says lung cancer is the leading cause of cancer death in Australia and has the lowest five-year survival rate (17%) of the five most commonly diagnosed cancers. It calls on decision makers to address “the disjointed care, mental health [issues] and stigma that Australians with lung cancer face – and make lung cancer a fair fight”.
According to LFA, 28% of people with lung cancer who are not staged when diagnosed are potentially missing out on life-changing treatment. This may be due to them being too ill to undertake staging investigations, therapeutic nihilism and distance from oncology services.
To address this, it recommends increasing access to lung cancer clinical nurse specialists and care coordinators at the time of diagnosis, as well as access to multidisciplinary teams during treatment.
“People without access to care coordination are at a greater risk of therapeutic nihilism, especially in people with advanced and terminal disease,” says the report, which also calls on the Australian Safety and Quality Commission in Health Care to measure therapeutic nihilism in lung cancer treatment.
It highlights delayed diagnosis a significant problem, as only 11.7% of people with lung cancer are diagnosed with stage I cancer, compared with 35.9% with prostate cancer, 42.8% with breast cancer and 22.1% with colorectal cancer. Diagnosed patients wait up to two months for treatment, and 20% receive no treatment at all.
And all these challenges are amplified for people living in a regional or remote area. While they represent 29% of Australians living with lung cancer, nearly half of them (49%) are diagnosed with stage III-IV, the report notes.
Professor Kwun Fong, chair of the Lung Foundation’s cancer consultative group told the limbic he strongly supports the report’s focus on patients getting more timely access to diagnosis and treatment.
He is recruiting former smokers from across Australia for the International Lung Screen Trial (ILST), which he says has achieved earlier detection using CT scans and a 20% reduction in mortality.
Professor Fong, senior staff specialist and clinical manager at Brisbane’s Prince Charles Hospital pulmonary malignancy unit, says clinical nurse specialists would help people navigate the complex treatment pathways so they received treatment sooner.
“As far as I know, there are very few of them, but there is a wonderful model in breast cancer care.”
The Lung Foundation report also notes a high unmet need for management of anxiety and psychological distress among people diagnosed with lung cancer.
“Clearly, we can, and must, do more to support Australians living with lung cancer mentally and emotionally, on top of improving access to best practice care to manage their lung cancer,” says Dr Nicole Rankin, Cancer Council NSW, Senior Research Fellow.
“The recommendations, as outlined in the report, aim to ensure thorough screening of all lung cancer patients to better determine individual psychosocial support needs, complete mental health plans and then refer for help as early as appropriate.”
Efforts are also needed to tackle the high levels of stigma in society about lung cancer, which may induce a sense of guilt among people with the disease and lead them to hide their disease from family and friends and avoid seeking treatment until too late.
The report calls for funding for public awareness and education campaigns to drive support, understanding, and empathy at a community level.