TOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH

Transcription

1 Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues, Please find attached a lung cancer lcal management update prduced by Dr Andrew Wight, Cnsultant Respiratry Physician at WUTH. Please als nte the message belw frm Dr Wight. Fr all 2 week wait suspected cancer referrals culd all clinical infrmatin be faxed within 24 hurs f referral. It has been brught t my attentin that 2ww referrals are being made thrugh chse and bk and then there is a delay befre the letter is sent with sufficient clinical infrmatin. This infrmatin is required t arrange the mst apprpriate test fr patients and delaying the letter will result in a delay in investigatin. Please send this infrmatin n the same day as referral. I hpe yu find this useful. Please cntact me if yu any queries. This will als be upladed nt the members sectin f the CCG website fr future reference. Dr Jane Fletcher Wirral CCG - Cancer and End f Life Lead Actin required please Fr infrmatin

2 Wirral Lung Cancer Tp tips and Update Fllwing a recent meeting with Dr Jane Fletcher it was suggested t put tgether suggestins fr lcal management f lung cancer, t imprve ur management between primary and secndary care. We have revised ur management f lung cancer patients in the last 6 mnths s initially it may help t explain changes and hw this may alter the way we suggest patients are managed prereferral. The pathway is als in appendix. Fllwing receipt f a 2WW referral with suggested lung cancer (either n basis f abnrmal CXR/CT, symptms as per NICE and/r high clinical suspicin) all referrals are reviewed n a daily basis by cnsultant. If required a CT scan is rganised at this pint, which is dne in the next 1 4 days. We have intrduced a cnsultant led virtual review clinic at day 5 7 pst referral. The referring infrmatin, images and current patient recrd is reviewed and management plan is decided prir t the first clinic appintment. If required further imaging (eg PET scan) and/r detailed lung functin (if pssibility f surgery/radical treatment) is requested fr the next week, prir t OPD appintment. The best methd f invasive investigatin/bipsy is identified and pre bked, if pssible n the day f utpatient clinic. Clinic appintment is in the next week (by latest 14 days pst referral frm primary care). If any tests are pre arranged the patient is cntacted by ur lung cancer specialist nurses prir t first appintment (patient phned within ne week frm primary care referral) t explain what has been arranged and answer queries. The patient is als given cntact details at this pint. We are currently cmpleting a patient satisfactin questinnaire but ad hc feedback n this prcess f early phne cntact (pre clinic review, after CT scan) has thus far been very psitive. We have intrduced this pathway in the last 6 mnths and have had very psitive results frm pst intrductin audit, shwing quicker investigatin times ( we have met all natinal targets fr the last 6 mnths) less invasive tests and less prcedure cancellatins less visits t utpatient appintments fr patients. We are currently lking at further refining the pathway t streamline care between primary and secndary care (and wuld welcme any feedback), including the pssibility f a straight t CT scan fr flagged, abnrmal CXR s. In discussins there were a number f pints that were raised.

3 Wh/when t refer? This is summarised by NICE guidance (see appendix) Acutely unwell immediate hspital referral CXR shuld always be arranged in primary care. Management can be guided frm this CXR flagged/suggests CT fr pssible lung cancer r nging unexplained haemptysis Please refer with this under 2WW. We will rganise CT scan CXR nrmal if nging cncern either (depending n trigger symptm/signs) Refer under 2WW depending n degree f clinical cncern/symptms (as per NICE) Arrange urgent CT scan in cmmunity which will be dne and reprted in 4/52 If rganising CT scan fr lung cancer this shuld be requested as CT chest/abdmen with cntrast (nt high reslutin CT chest/hrct). We wuld ask that flagged CXR s suspicius fr cancer are at present referred under 2WW and nt investigated in primary care as this leads t delays in prbable cancer diagnses. Referral details We wuld ask that faxed 2WW referrals are sent ASAP if phning t arrange referral. It is nly with faxed inf that we can start ur pathway and decide n suitable investigatins. We have ccasinally fund delays f up t a week fr the fax t cme thrugh. We wuld ask that a list f medicatins is sent with the 2WW referral. We need t knw this t be able t pre arrange invasive test (especially anticagulatin/insulin etc). Anything else that can be dne n referral t help? We wuld ask if pssible that bld tests are requested n referral. Fr CT cntrast up t date renal functin is required, and leads t delay if nne available. If testing this we wuld ask that all bld tests are cmpleted at the same time (t save repeated sampling fr patients) FBC U/E LFT Calcium INR/cag

4 High emergency presentatins in Wirral We have high emergency presentatins f lung cancer lcally (40 45% f diagnses) due t many factrs. Such presentatin has wrse prgnsis and generally pints t mre advanced disease. Early recgnitin/diagnsis is key fr ptential curative treatment which wuld be ur aim. We wuld recmmend a lw threshld fr CXR referral fr thse with chest symptms (especially in high risk grups smkers, asbests expsure, family histry etc), as per new 2015 NICE guidance attached. On recent lcal audit f 3 mnths 2WW cancer referrals nly 3/36 had nrmal CXR s s this shuld always remain first investigatin f chice. Wh t cntact if cncerned? Fr patients currently being investigated/knwn t the lung cancer services the best cntacts are the lung cancer specialist nurses Kay Hughes r Anita Gillen, r the named cnsultant fr their care via their secretary. The lung cancer specialist nurses can be cntacted n Fr advice pre referral please cntact Dr Andrew Wight via secretary n

5 Appendix NICE Guidance (NG12) Published June 2015 Lung cancer Recmmendatins in this sectin update recmmendatins t in lung cancer, NICE guideline CG Refer peple using a suspected cancer pathway referral (fr an appintment within 2 weeks) fr lung cancer if they: have chest X-ray findings that suggest lung cancer r are aged 40 and ver with unexplained haemptysis. [new 2015] Offer an urgent chest X-ray (t be perfrmed within 2 weeks) t assess fr lung cancer in peple aged 40 and ver if they have 2 r mre f the fllwing unexplained symptms, r if they have ever smked and have 1 r mre f the fllwing unexplained symptms: cugh fatigue shrtness f breath chest pain weight lss appetite lss. [new 2015] Cnsider an urgent chest X-ray (t be perfrmed within 2 weeks) t assess fr lung cancer in peple aged 40 and ver with any f the fllwing: persistent r recurrent chest infectin finger clubbing supraclavicular lymphadenpathy r persistent cervical lymphadenpathy chest signs cnsistent with lung cancer thrmbcytsis. [new 2015]

6 Mesthelima Refer peple using a suspected cancer pathway referral (fr an appintment within 2 weeks) fr mesthelima if they have chest X-ray findings that suggest mesthelima. [new 2015] Offer an urgent chest X-ray (t be perfrmed within 2 weeks) t assess fr mesthelima in peple aged 40 and ver, if: they have 2 r mre f the fllwing unexplained symptms, r they have 1 r mre f the fllwing unexplained symptms and have ever smked, r they have 1 r mre f the fllwing unexplained symptms and have been expsed t asbests: cugh fatigue shrtness f breath chest pain weight lss appetite lss. [new 2015] Cnsider an urgent chest X-ray (t be perfrmed within 2 weeks) t assess fr mesthelima in peple aged 40 and ver with either: finger clubbing r chest signs cmpatible with pleural disease. [new 2015]

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