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  P3.07 - Nursing and Allied Professionals (Not CME Accredited Session) (ID 973)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27547

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    P3.07-07 - Multidisciplinary Supportive Care Assessment in Lung Cancer – A Case Study Example (ID 11801)

    12:00 - 13:30  |  Presenting Author(s): Faye Louise Dickinson
    • Abstract
    • Slides

    Background
    

    Although many patients report positively on their experience of cancer care, their Supportive Care (SC) needs may not be met for several reasons, including services not being universally available, poor recognition of needs and poor inter-professional communication (NICE, 2004). Guys and St Thomas’ NHS Foundation Trust has a dedicated SC service for lung cancer patients consisting of specialist Dietetics, Occupational Therapy (OT), Physiotherapy (PT) and Speech and Language Therapy (SLT). Here we describe a complex case study requiring extensive multimodal SC interventions.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Patient X was a 46 year old female with adenocarcinoma of the left lung T4N3M1b diagnosed August 2017. She presented with shortness of breath, chest wall pain, dysphagia, dysphonia, anorexia and weight loss. She received 3 cycles of first line chemotherapy, 3 cycles of 2nd line Pembrolizumab and a single fraction of stereotactic radiotherapy for brain metastases. She died in January 2018.

    4c3880bb027f159e801041b1021e88e8 Result
    

    On initial dietetic assessment the patient had lost 16.5% of her body weight over the previous 4 months. Dysphagia and anorexia resulted in her only managing puree textures and liquids resulting in a significant nutritional deficit. She received dietary counselling and oral nutritional supplements to optimise her intake and minimise further weight loss.

    She received PT and OT intervention for fatigue, reduced mobility, deconditioning and reduced occupational performance within the clinic, including education regarding strengthening exercises, fatigue and breathlessness management. She was referred on to community services to progress her rehabilitation and assess equipment needs within the home setting.

    SLT provided assessment and management of oropharyngeal dysphagia and dysphonia. She was supported to use a left head turn swallow strategy to reduce the risk of aspiration. In addition vocal hygiene advice and education was provided, aiming to prevent vocal strain.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Patient X benefited from assessment and intervention by a range of SC therapists which may have prevented aspiration pneumonia, minimised her weight loss and increased her functional independence thus having a significant impact on her quality of life. In many centres access to SC services may result in a high appointment burden and non-specialist intervention. Providing these services as part of a one stop MDT clinic prevented additional appointments and ensured effective communication between the MDT, so that medical and supportive goals were aligned. It can be argued this should be gold standard care for all lung cancer patients. To support this argument more robust clinical outcomes and patient experience data needs to be collected.

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