Six urgent lung cancer reforms needed to reverse years of stagnation

Lung cancer

By Michael Woodhead

4 Aug 2022

Six key reforms are needed to address systemic gaps in lung cancer diagnosis and treatment in Australia, according to a new report from the Lung Foundation.

As well as implementing the recommended national lung cancer screening program, there is also a need for government-funded Comprehensive Genomic Profiling as standard of care for Australians with lung cancer and a national clinical quality registry, the Foundation argues.

Its report also calls for urgent funding for 100 specialist lung cancer nurses, renewal of stalled lung cancer prevention strategies such as smoking cessation programs – and better support for lung cancer survivors dealing with anxiety and depression.

Lung Foundation chair Mark Brooke said the report was an opportunity for the new Labor government to take action after years of inaction on the nation’s biggest cancer killer.

He said reforms were urgently needed for patients who still experienced delayed diagnosis and treatment, lack of specialist cancer care and a five year survival rate of only 20%.

“Despite incredible scientific advancements and significant new treatments now available, it is devastating to reflect, and see, that four years on from our first report of this kind released in 2018, improvements in lung cancer care across the country have been limited.

“We felt it was a watershed moment when the former Health Minister announced a scoping study on a national lung cancer screening program – but when the rubber hit the road, we’ve not seen this funded despite evidence of its impact,” he said.

“It hasn’t been good enough, but we have faith that this new government will not leave those with lung cancer behind,” said Mr Brooke.

As noted in a landmark inquiry, a national low dose CT lung screening program will save 12,000 lives over 10 years and should be funded in the October budget, the report recommends.

It also recommends investment in 100 specialist lung cancer nurses by 2025 to care for the 22,800 Australians currently living with lung cancer.

“Of the only 37 Specialist Lung Cancer Nurses in Australia, each must tend to a staggering 616 patients. Such a reality is beyond unfair to them and those in need of urgent, specialist care,” said Associate Professor Lucy Morgan, Respiratory Physician and Lung Foundation Australia Board Chair.

“This is a stark comparison to other cancers, with one nurse for every 185 patients with breast cancer, and more than double the number of prostate nurses than lung,” she said.

“Those with access to a Specialist Lung Cancer Nurse are 44% more likely to receive treatment than those who do not and are more likely to experience reduced wait times from referral to treatment, improving the potential of better health outcomes, as well as playing a critical role in wellbeing and reducing mental and psychological distress.”

The report also recommended that comprehensive genomic testing be funded for lung cancer patients because it will provide greater diagnostic accuracy, targeted treatment options and improved patient outcomes, as well as cost savings.

Currently, MBS-funded tests are mostly single gene tests or small panels, which means that patients endure ‘testing odysseys’ of multiple tests before a useful biomarker is identified. This approach is hampered by insufficient biopsy tissue being available for multiple successive tests, and high costs for some genomic tests.

“Inequitable clinical access to CGP is an issue in the absence of MBS funding, as only patients who can afford to pay thousands of dollars out of pocket are able to receive the tests,” the report noted.

The report’s lead author, Professor Nicole Rankin, Head, Evaluation and Implementation Science Unit, University of Melbourne said the recent pandemic had highlighted the need for decisive and strong action on lung cancer detection and treatment.

“The COVID-19 pandemic has significantly impacted the Australian health system and reduced the delivery of cancer diagnostic and treatment services; many lung cancers remain undiagnosed and an influx of lung cancer referrals is expected in coming months and years,” she said.

“[This] Blueprint provides us all with a framework to drive significant and positive change over 2022- 2025 that transforms lung cancer from a fatal condition to one that is treatable.”

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