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Andrea McIver
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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: 2
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.07-04 - Early Lung Cancer Team Intervention in Emergency Admissions (Now Available) (ID 919)
09:45 - 18:00 | Author(s): Andrea McIver
- Abstract
Background
The Liverpool Lung Cancer Unit is a unique diagnostic service diagnosing approximately 430 patients per year. Although the majority of cases of suspected lung cancer can be managed as outpatients where the diagnostic pathway is well developed, a proportion still present unwell via the emergency department where their subsequent journey is less certain. Along with same-day reporting for emergency scans, we have developed a rapid review service for such individuals and were interested in assessing its performance.
Method
We looked at all patients with suspected lung cancer who presented through our emergency department at The Royal Liverpool University Hospital in 2018, focussing on outcome, time to be seen following admission, and the histological diagnosis rate.
Result
Of the 561 referrals to our lung cancer unit, 196 (35%) presented through the emergency department: 73 (37%) were discharged to outpatient cancer investigation. The remaining 123 (63%) were admitted to 26 different locations (8 medical specialities, surgical, vascular and orthopaedic wards).
Of these, 72% were seen by the lung CNS within one working day and appropriate management initiated. This was aided by our live CT scan database, where 69/79 (87%) were coded on the same day. Daily CNS checks of the database ensure early inpatient identification and review by the lung clinician and CNS, often before formal referral from the responsible clinical team is made.
Overall 103 patients (84%) who presented as emergencies subsequently were diagnosed with a malignancy. 96 were diagnosed with a primary lung cancer of which 56 (58%) had histological confirmation.
Conclusion
Our results show that, by coordinating care between the emergency and radiology departments and the lung cancer team, patients presenting unwell can be managed rapidly even if they remain in hospital. In addition, by actively seeking them out we can not only provide them with timely and appropriate investigations but also early CNS intervention, facilitating symptom management, the opportunity to maximise their performance status and offer psychological support to not only the patient but to their families as well.
This approach also ensures that the managing medical teams are given the right information from a specialist team. The Lung Cancer Team resource is therefore focussed on looking after lung cancer patients and those patients that do not have cancer but are referred to the team are informed at the earliest opportunity and treatment decisions made accordingly by the team responsible for their care.
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P1.07-11 - An Evaluation of the Patient’s Experience and Expectations During the Implementation of NHS England, National Optimal Lung Cancer Pathway (Now Available) (ID 124)
09:45 - 18:00 | Author(s): Andrea McIver
- Abstract
Background
The NLCFN workshop group were keen to explore the impact on patient experience of the National Optimal Lung Cancer Pathway (NOLCP).
Evaluation of patient experience to collect data on their corresponding pathways.
Hospital based lung cancer diagnostic services across the UK at 18 Trusts.
Method
Newly diagnosed lung cancer patients referred on the 62 day pathway during October 2017 to July 2018 were eligible. 135 patient pathway and questionnaire data were analysed from 15 Trusts.
Data Collection
Data collection was in two parts: A patient survey and a data collection tool to reflect key points along the patient pathway. All data was anonymised.
Data Analysis
Data was submitted by 15 Trusts and analysed by the workshop participants
Result
Overall, patients were satisfied with their experience of the pathway.
Data collection demonstrated significant variation across pathways.
Service evaluation and development is a key part of the LCNS role, however there were variations in Trust governance processes which caused delays and non submissions.
Conclusion
Overall, patients were satisfied with their experience of the pathway.
Data collection demonstrated significant variation across pathways.
Service evaluation and development is a key part of the LCNS role, however there were variations in Trust governance processes which caused delays and non submissions.
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P2.05 - Interventional Diagnostic/Pulmonology (ID 168)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Interventional Diagnostics/Pulmonology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.05-07 - The Liverpool "Straight to CT" and "Virtual Working" Lung Cancer Pathway – 5 Years On (Now Available) (ID 909)
10:15 - 18:15 | Author(s): Andrea McIver
- Abstract
Background
Streamlining the diagnosis of lung cancer is pivotal to improving outcomes and thereby the quality of the patient journey. As part of this, in 2014 Liverpool introduced the concepts of “straight to CT” (where patients with suspicious imaging or symptoms have a directly arranged rapid [< 72 hours] CT scan), and also the “virtual assessment” service (where those with scans suggestive of lung cancer are contacted by a lung CNS and the initial clerking and investigation planning is made by telephone) into its lung cancer diagnostic pathway This pathway is now in its 5th year and we report our experience.
Method
As regards “straight to CT”, there has been no increase in the demand for outpatient scan capacity for suspected lung cancer (about 400 scans per year). Patients with scans arranged in primary care without suspicious changes remain in the community, but those with other changes can be referred to a general chest clinic (21%). Of those who enter the virtual assessment pathway, 81% are diagnosed with lung cancer.
Result
To date, approximately 1200 patients have been through the “virtual assessment” service. Audit has shown that 98% prefer telephone assessment rather than physical clinic attendance, and most wish to be called on the same day as the scan. Patients feel that they had been given correct and timely information and feedback from primary care colleagues is uniformly positive. Lung CNS job satisfaction has improved since skills are now focussed more appropriately.
Although the cancer unit diagnoses about 400 cases per year, using the virtual working model means that on average only 7 physical patient clinic attendances per week are necessary to provide the service, thereby greatly reducing resource use, saving 40% of costs overall. Furthermore, the more efficient service easily exceeds the 14 and 62 day cancer targets (99% and 97% respectively).
Conclusion
Many lung cancer services are now moving towards “straight to CT” and virtual working models. Our experience is positive, and we would recommend its adoption.
