Author of

• 11001

  +

  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11042

    +

    P1.24-041 - Follow up of patients with lung cancer: the role of primary care (ID 2981)

    09:30 - 16:30  |  Author(s): R. Neal
    • Abstract

    Background
    Despite improvements in lung cancer treatments, there is little international agreement over the key elements of follow-up; frequency of visits and investigations, and choice of models of care remain controversial. Worldwide there is an emphasis on survivorship in patients who have been treated for lung cancer. Further, there is growing interest in the role of primary care in cancer survivorship and follow-up; primary care has the potential to provide more comprehensive and coordinated care in cancer patients. To date there have been few studies investigating the role of primary care in lung cancer follow-up and survivorship. As a prelude to developing and trialing a primary care-focused package of care for UK patients with lung cancer, we undertook a descriptive study, based on analysis of audit, database and qualitative data.

    Methods
    Case notes of 183 lung cancer patients from 60 practices in Wales Scotland and England , and data from two Scottish primary care databases (3025 patients) were analysed (attendance patterns in primary care, co-morbidity, investigations, referrals and prescribing). For a subset of database patients, data from control patients, matched for age and sex, were examined. We also interviewed 84 primary and secondary health care professionals from across the UK, and undertook four focus groups of patients and carers. Transcripts were coded thematically using a grounded theory approach; the analysis was conducted inductively, driven by the interview data.

    Results
    Most (90%) of the patients’ cancers were NSCLC; 57% had received treatment with 'curative intent'; the remainder received essentially palliative treatment. Three-quarters of patients had at least one co-morbidity (32% had two or more). Particularly in the first year post-diagnosis, lung cancer patients had significantly higher primary care consultation rates than matched controls - these differences persisted over time. Approximately 80% of presentations to primary care were for lung cancer-related problems; almost 20% of all primary care consultations led to investigations (predominantly blood tests), and 7% led to a referral. Most prescriptions were for antibiotics, analgesia and antidepressants. There was little evidence of structured approaches to lung cancer follow-up and survivorship. Our qualitative data showed some support amongst key stakeholder groups for an enhanced role for primary care in the follow-up of lung cancer patients. There was, however, a strong perception of 'disaggregation' between secondary and primary care services. Care models involving enhanced roles for primary care were particularly favoured for long-term lung cancer ‘survivors’, with a high burden of psycho-social concerns and unmet need; also, the role of specialist lung cancer nurses was consistently emphasised.

    Conclusion
    Much of the care provided to lung cancer patients is already based in primary care. Further, specialist nurses provide expert knowledge, familiarity with and access to hospital-based services and engagement with multi-disciplinary team processes. There is, however, limited evidence from our study or the wider literature that the services needed to meet the broad and complex needs of these patients are well-defined or well-integrated. Models which integrate primary care with other lung cancer services offer the prospect of improved continuity, access, care co-ordination and management of co-morbidities.