Development of Lung Cancer Networks

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Development of Lung Cancer Networks

• Dr John Gaddie

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Workplan

• Published in the SCAN Annual Report
• Identifies Leads from Group for areas such as
  Redesign, Protocols, Audit, IMT, Service maps
  and Education.
• Timescales agreed
• Agenda for each quarterly meeting centers on it

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Redesign Protocols (Chemotherapy, CHART)Audit
/ Information(IMT Clinical Oncology
System)Service maps Clinical TrialsEducation
SCAN Lung Group Workplan
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SCAN Lung GroupProtocols published on
www.scan.scot.nhs.uk

• This document represents the current guidance
  used to support clinical decision making and
  management by appropriately trained and
  experienced clinicians working within the SCAN
  multidisciplinary group.

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IMT Clinical Oncology System

• Aims

• build one generic system for all cancers that
  will work across the whole of the SCAN region.
• Ensure that patient information is available at
  the point of contact and truly supports the
  complex journeys of care across many geographical
  areas.

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Scottish Cancer Research Network

• Aims
• double patient recruitment to trials
• Increase awareness of benefits of trials.
• .and in turn improve patient care
• Progress
• Nov 2002 Initial Plan approved
• Feb Sept 2003 Key staff appointed (Clinical
  Lead David Cameron and Co-ordinator Ruth McLaren

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• General Practice Referral - Part 1
• Haemoptysis
• Persistent or unexplained (more than 3 weeks)
• Cough
• Chest/Shoulder pain
• Dyspnoea
• Weight loss
• Hoarseness
• Finger Clubbing
• Chest Signs

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• General Practice Referral - Part 2
• Persistent or unexplained (more than 3 weeks)
• Features suggestive of metastases from a lung
  cancer (brain, bone, liver, skin)
• Persistent cervical/supraclavicular
  Lymphadenopathy
• Fatigue in a smoker over 50 years
• 90 smokers or ex-smokers
• Chest X-Ray open access

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• Patient Pathway
• Referral Letter within 5 working days
• Radiology meeting Friday Morning
• Referral letter
• Chest x-rays reviewed
• 3 New Patient Appointment
• CT Scan slots Monday at one stop clinic

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• One Stop Clinic Monday - Part 1
• Clinical Oncology Nurse input
• History and Examination
• Performance status
• Current weight weight loss
• Investigations
• Haematology
• Biochemistry Serum calcium
• Liver function tests
• Urea and electrolytes
• Lactic dehydrogenase

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• One Stop Clinic Monday - Part 2
• Investigations
• Lung Function Tests
• Arterial Blood Gas Tensions
• CT Scan Thorax/liver
• Fibre-optic bronchoscopy and biopsies
• Sputum cytology x 3
• Patient offered clear truthful explanation of
  disease

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In-Patient Referral - Part 1

• Referral from hospital Clinician - lt 5 days 81
• Orthopaedics Pathological fracture
• Bony metastases
• Neurologist Epilepsy
• Stroke
• Cerebral metastases
• Gastroenterologist Jaundice
• Hepatic metastases

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In-Patient Referral - Part 2

• Cardiologist Arrhythmias atrial fibrillation
• Cardiac Involvement
• General Physician Pleurisy
• Pleural effusion
• Weight loss
• ENT Surgeon Hoarseness
• Vocal cord palsy

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Multidisciplinary Meeting Thursday - Part 1

• Clinical Oncology Nurse input
• Medical Oncologist
• Consultant Radiologist
• Respiratory Physician
• Palliative Care Physician
• Nurses
• Physiotherapist
• Pharmacist
• Occupational Therapist

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Multidisciplinary Meeting Thursday - Part 2

• Telemedicine Link development
• Pathologist
• Thoracic Surgeon
• Combined Meeting
• Clinical findings
• Radiology Chest X-ray
• CT Scan thorax/liver
• Bronchoscopy findings (video)
• Pathology CT Guided Biopsy
• Peripheral lesions
• Audit Data Collected

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First seen by a respiratory physician to date of
Bronchoscopy and CT ScanThe times indicated are
the median values of patients recorded on SCTN
databases diagnosed with lung cancer between
1/11/2000 and 31/10/2001
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Representation of the patient pathway from GP
referral to First Definitive Treatment .The times
indicated are the median values for patients from
SCTN databases diagnosed between 1/11/2000 and
31/10/2001
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Time (days) from GP referral to specific first
definitive treatment.The times indicated are the
median values of patients from SCTN databases
diagnosed with lung cancer between 01/11/2000 and
31/10/2001
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Audit of One Stop Clinic - Part 1

• Local Health Council
• Patient view of all investigations at one-stop
  clinic
• Patient received sufficient information about
  what to expect at one-stop clinic
• Method
• Questionnaire on day of visit to complete and
  return to the Local Health Council
• 6 months 31 patients, 23 completed
• Response rate 74

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Audit of One Stop Clinic - Part 2

• Patient view of all investigations
• 21 appropriate
• Patient view of sufficient information about
  visit
• 21 enough information
• Conclusion issues important to patients
• Information
• Staff attitude and communication
• Getting diagnosis quickly and efficiently