Deficiencies in specialist lung cancer services contribute to poor outcomes

Lung cancer

By Mardi Chapman

31 Jan 2022

Professor Fraser Brims

Critical caps in the provision of key health professionals and other resources for the management of lung cancer have been highlighted in an audit of lung cancer services across Australia.

A survey of 79 institutions across all Australian states and territories found just 48.5% of sites overall employed lung cancer nurse specialists. Even fewer nurses were employed in regional areas and in sites with low case volumes.

The study, published in BMJ Open Respiratory Research, said 73 of the 79 sites had a lung cancer multidisciplinary team (MDT) and of those only 42 (57.5%) fulfilled core membership and none fulfilled full recommended membership.

In particular, thoracic surgery was represented at 76.7% of sites overall and less at regional sites and those with low case volume.

Lead investigator Professor Fraser Brims, from Curtin University and Sir Charles Gairdner Hospital, told the limbic having full membership on the MDT was highly desirable and particularly regarding thoracic surgeons.

“We know that access to thoracic surgery for early stage lung cancer is the best chance of cure,” he said.

“And we also know that specialist nurses improve access to systemic cancer therapy and provide vital holistic support for patients and families so there is a really clear impact on patients when they are not available.”

The survey also showed that PET-CT was available on site at 76.7% of the institutions and EBUS bronchoscopy at 79.5%. Again, the proportion was lower in regional areas.

Thoracic surgery was available on site at 76.7% of institutions, external beam radiotherapy at 76.7% and stereotactic ablative radiotherapy at 65.8%.

“We can’t expect those specialised resources to be in each and every centre but I think we do know that timely access to those sorts of investigations and ultimately timely diagnosis can make a difference, particularly in early stage cancer.”

“That’s partly why we have seen consistent data from Victoria and NSW, that regional and rural patients with lung cancer have worse outcomes compared to metropolitan patients.”

Professor Brims said the increased use of virtual and hybrid meetings as a consequence of COVID-19 at least offered a partial solution to gaps at the MDT meeting.

He said the survey revealed strong support for a national lung cancer registry.

“There is a lot of potential interest and support for lung cancer screening although no firm funding and Cancer Australia are very clear that the scope of what they have been asked to look at stops at a suspicious lung cancer being referred to a centre.”

“So we won’t know any of the long term or downstream outcomes from people being screened in Australia without having a clinical quality data platform to follow that through. That’s just one of many potential benefits,” he said.

Professor Brims said it was time for a change from the stigma and bias against lung cancer that has pervaded for a couple of decades.

“Lung cancer is changing, the treatments are changing and we need more specialised care and to ensure centres are providing the appropriate level of care.”

“From the grass roots up, we need to petition our institutions and local health care resource planners to improve services. And we can certainly use this paper as part of the increasing literature to justify why we need change.”

“At a wider level, it is time for national and state governments to start taking lung cancer more seriously, both in research funding and direct health infrastructure.”

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