End of Life Care in Lung Cancer: Lessons learnt through the Lung Cancer Pathways and Practices Jane E Scullion Respiratory Nurse Consultant University Hospitals of Leicester
To cover What works well? What doesn't work so well? Where are there similarities? What are the learning points?
Background: Lung Cancer Lung cancer the UK’s biggest cancer killer 1:5 of all cancer deaths 35,371 deaths pa 44,488 new cases per annum (2012) (24,005 men 20,483 women) (2012) Compared to the European average, cancer survival in England is low 5% at ten years Late presentation 34% of all lung cancer patients in UK currently diagnosed as an emergency
Background: COPD 1.2 million people with COPD (2% of the population) COPD deaths per annum 28-30,000 UK in top 20 countries for COPD mortality world wide In Europe only Denmark and Hungary have higher death rates. However UK lower than US and New Zealand 115,000 New Cases pa. 1 diagnosis very five minutes 10% more males than females 15% due to workplace exposure = 4,000 deaths pa (HSE Oct 2015) 26% die within a year of diagnosis 34% of all COPD admissions are undiagnosed at admission
Shared problems Stigma Lack of understanding of signs and symptoms Often frequent consultations before diagnosis so worse experience of care and potentially worse outcomes (BLF) Old age Social deprivation
Shared problems Nihilism Lack of investigation Co-Morbidity Training and Education of HCP Risk stratification - lifestyle clinical history
Supported by an MDT approach and Lung Cancer Nurse Specialists Lung Cancer pathway CT Primary Care Urgent Referral First Specialist Assessment Decision to treat First Treatment Supported by an MDT approach and Lung Cancer Nurse Specialists Set within a time scale
Diagnostic Pathway Lung Cancer Prevention Screening Diagnosis Recovery Treatment Palliation /EOL
Diagnostic Pathway Lung Cancer Prevention Screening Diagnosis Recovery Treatment Palliation /EOL
Diagnostic Pathway Lung Cancer Prevention Screening Diagnosis Recovery Treatment Palliation /EOL
Diagnostic Pathway Lung Cancer Prevention Screening Diagnosis Recovery Treatment Palliation /EOL
Diagnostic pathway Lung Cancer Prevention Screening Diagnosis Recovery CNS Treatment Palliation /EOL
Diagnostic Pathway: COPD Prevention Screening Diagnosis Stability Treatment Palliation /EOL
Or Stability Prevention Treatment Diagnosis Palliation /EOL Screening
Prevention Smoking Cessation Workplace surveillance
Screening Risk stratification - lifestyle clinical history Direct access for tests Linked up communication / records
Diagnosis
Patient experience Unnecessary investigation Poor symptom management Lack of recognition of end of life Delays in discharge Inadequate communication
ELCWP Develop recommendations to address late diagnosis Improve outcomes Best possible treatment and care Access to specialist nurses - key members of the MDT support for patients and coordination
Best practice Awareness Smoking status CXR Follow up Investigation and referral Template Audit
Learning points
Learning points