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MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:Joaquim Bosch-Barrera, Virginia Calvo De Juan
- Coordinates: 9/10/2019, 11:30 - 13:00, Interlaken (1988)
MA19.09 - Assessing Clinical Frailty in Advanced Lung Cancer Patients - An Opportunity to Improve Patient Outcomes? (Now Available) (ID 2363)
11:30 - 13:00 | Author(s): Marie Eaton
The median age of non-small cell lung cancer (NSCLC) diagnosis in England is 73 years. At that age, 40% of the general population has some degree of clinical frailty which may impact survival, quality of life, anti-cancer treatment tolerability and access to clinical trials. However, clinical frailty is often not addressed or managed at the time of anti-cancer treatments. This project was designed to integrate frailty assessments and build frailty pathways within an advanced cancer care setting in order to better support patients and improve outcomes.Method
This quality improvement project that used Plan-Do-Study-Act (PDSA) methodology. Phase one of the project focused on establishing a multidisciplinary team to integrate a frailty screening tool, the Rockwood Clinical Frailty Scale (CFS), into standard clinical practice. The primary aim was to implement and screen ≥80% of all new lung cancer patients at a high-volume tertiary cancer centre. The secondary aim was to explore the correlation of CFS with age, performance status (PS), treatment selection and systemic anti-cancer treatment (SACT) tolerability. Specialised training was provided to the clinical team and the CFS was integrated from 26/11/2018 on an electronic form routinely completed by clinicians. A digital dashboard was set-up to monitor real-time data and the frail group was defined as CFS score >3. Data cut-off for this analysis was 29-03-2019.Result
335 lung cancer patients were screened using CSF by a team of 20 clinicians with a compliance rate of 89%. There was a strong correlation between PS and CFS (r= 0.77, p<0.01). The distribution of both CFS and PS correlated with ageing (r= 0.2 and r= 0.17, respectively; p<0.01). Patients ≥70 years were more likely to be frail (56% vs 40%; OR 1.4, 95%CI 1.2-1.7; p<0.01). Frailty reduced the likelihood of receiving any anti-cancer treatment by 20%. Amongst those who started SACT, patients classed as frail were less likely to go beyond the first cycle of treatment (64% vs 91%; OR 0.7, 95%CI 0.5-0.9; p<0.01).Conclusion
CFS screening is feasible within a busy clinical practice when incorporated as a digital tool. CFS helps to identify patients who may potentially benefit from specialised frailty assessment and management. This could ultimately be used to better inform on treatment selection, and support requirements during treatment, to improve outcomes for patients in the future.
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P1.07 - Nursing and Allied Professionals (ID 171)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Nursing and Allied Professionals
- Presentations: 1
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
P1.07-05 - Developing a Nursing Triage Tool to Assess Patient Support Needs Through Treatment for Lung Cancer (ID 541)
09:45 - 18:00 | Author(s): Marie Eaton
Improvements in treatments and outcomes within lung cancer has resulted in an increasing number of patients requiring access to appropriate support. Within a tertiary specialised centre for the treatment of lung cancer, stratification of support is required in order to target the patients with the greatest needs and identify services to sign post them to. The Lung cancer Clinical Nurse Specialists (LCNS) are developing a triage tool which uses a red, amber, green approach to stratifying need. It assesses 10 areas of patient vulnerability. On completion of the assessment, those with particular needs will be triggered by an amber or red flag. The tool will proactively identify patient need, whilst helping the LCNSs to work towards a manageble caseload.Method
The LCNS team had been assessing patient need through intuition, using their own criteria. The aim of the tool was to create a consistent approach to this assessment and led to the identification of key areas of patient vulnerability. Already validated tools for these key areas were incorporated into the design. A scoring system was developed against each key area and the tool was piloted on a number of patients in order to identify the boundaries of stratification. However, due to the variability in scores and inconsistent outcomes, scores were replaced with red, amber or green for each category. Any category resulting in an amber or red outcome, led to a more complex intervention.
All Green Outcomes: Information pack, LCNS contact details, referral back to local CNS
Any Amber Outcomes: In addition to the 'Green' interventions, a day 8 (of treatment) telephone consultation in nurse led clinic, Community referrals
Any Red Outcomes: In addition to the 'Green and Amber' interventions, follow up call post initial consultation, specialist service referralsResult
The tool will be further piloted by the LCNSs and interventions implemented in line with the outcomes. The aim is to roll the tool out across the Greater Manchester area so that it can be used by CNSs in the District General Hospitals and will be continually used throughout the patient pathway as their needs change. The resulting assessment will be recorded on the electronic patient record and therefore will be auditable across the patient population to ensure that LCNS patient interventions are at the appropriate level to the support need.
- Reduced hospital admissions
- Improved outcomes for patients
- Patient Satisfaction through service user feedbackConclusion
Identifying patient need through their cancer pathway has until now been a process of intuition and individual preference by each LCNS. This triage tool, whilst not replacing clnical judgement, is designed to remove the inconsistency of assessment and create a stratified approach to patient need. This will enable appropriate allocation of resources and provide auditable data to allow service improvement and ultimately enhance the patient experience.