The first-ever federal funding allocation for specialist lung cancer nurses is painfully small in dollar terms, but it might signal a shift in attitudes towards Australia’s deadliest cancer.
Of the $6.9 million outlay for lung cancer programs announced in the May Budget, it was revealed this week that $900,0000 will go to fund a two-year pilot training program for five specialist lung cancer nurses. The lion’s share is earmarked for second-phase development of a lung cancer screening program.
Dr Vanessa Brunelli, a leading Australian lung cancer nurse educator and researcher, says social stigma surrounding lung cancer and its link to smoking has led to long-term neglect of this patient group compared with other cancer patients. The stigma led to delay in treatment and also impacted lung cancer patients who never smoked, she added.
“It’s not as if they don’t deserve the same kind of help as patients with other cancers,” she told the limbic.
While the number of new lung cancer nurse training positions is far short of the 15 places sought by the Lung Foundation Australia and the funding is dwarfed by spending on specialist nurses in breast and prostate cancer, it represents a “breakthrough” in thinking, she said.
“It signifies that the federal government has acknowledged for the first time that that lung cancer is a real problem in this country, and we need to support people with lung cancer. We are on the map now, and the only way to go is up.”
Dr Brunelli, chair of the Australia New Zealand Lung Cancer Nurses Forum and a research fellow at Queensland University of Technology, said a survey conducted a few years ago found there were just 12 FTE specialist lung cancer nurses in Australia.
The “dismal” Australian number works out at one nurse for every 1000 patients, based on a rate 13,000 new cases per year.
By comparison, approximately 400 specialist lung cancer nurses work in the UK public health system – the equivalent of one nurse to about 140 patients in a country where 47,000 cases are diagnosed each year.
“A lot of my nurse colleagues certainly have upwards of 500 people with lung cancer on their books,” she said.
“If you have, say, 100 patients, each one might be at a different stage on the clinical pathway; some are newly diagnosed, some are undergoing treatment, some might be out of the hospital system and having follow-ups with their GP but still connected to the specialist lung cancer nurse.”
Nurse role in cancer journey
According to Dr Brunelli, in the specialist role a senior clinical nurse with targeted training and long clinical expertise is responsible for supporting patients with thoracic malignancy along every step of the cancer journey.
“They hold a unique position in that they are the one healthcare professional that is the constant across the clinical pathway. From when a patient is diagnosed until end of life, that nurse is the one unchanging point of contact, which is really important when you have people with no knowledge or experience of the healthcare system. It’s a very scary place to be.”
“It’s about helping the person navigate the hospital and health system and providing the right education for them at the right time and at the right level.”
The education role extends to smoking cessation and symptom management, encouraging ‘pre-habilitation’ to build physical fitness before treatment, and teaching carers how to manage a patient through episodes of breathlessness.
And inevitably, the expected national screening program for lung cancer will lead to a higher demand for specialist nurses as more patients are diagnosed at an earlier stage. Currently, 42% of lung cancers are diagnosed at stage 4.
“What that means is, if those patients have better outcomes, they are going to live longer as cancer survivors. In this country we are just not set up to support cancer survivors for a long time. We just don’t have the resources or the support at that longer end.”
Lung Foundation Australia CEO Mark Brooke welcomed the government’s support for LC nurses and the screening program but said much more was needed to “finally end the stigma” and achieve equity with other cancer communities.
“We know that specialised lung cancer care nurses play a crucial role throughout the health journey for patients with lung cancer, and we will continue to work with our advocates and clinicians to bridge the ongoing and significant gap in specialist care compared to the likes of breast and prostate cancer.
“We already know that screening works, so we want a lung cancer screening program not just piloted but fully implemented as soon as possible, and for it to include all Australians at risk of lung cancer, including those affected by silicosis and occupational exposure.”