Naveed Saleh, MD, MS, for MDLinx | October 22, 2018
The working practices of lung cancer nurse specialists (LCNSs) in the United Kingdom improved anticancer therapy uptake rates, particularly surgical treatment among eligible patients, according to a recent study in Lung Cancer.
“Treatment choices for people with lung cancer may be influenced by contact and engagement with LCNSs,” wrote the authors, led by Iain Stewart, PhD, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK. “Championing the LCNS role is an appropriate strategy to improve treatment rates, as contact and working practices are associated with receipt of treatment, potentially via improved patient comprehension of the disease and engagement with options.”
In the UK, lung cancer survival has improved considerably, but it is lower than in other parts of Europe. One issue is the unexplained variation in surgical resection rates for patients with non-small cell lung cancer, with most hospital providers failing to attain a 60% target rate for the fraction of people receiving anticancer surgery, chemotherapy, or radiotherapy.
The authors stressed the importance of increased treatment uptake to fuel improvements in lung cancer survival.
“LCNSs have a crucial role in an individual’s cancer journey as experienced professionals who case manage care, meet information needs, manage symptom control issues, support patients and families in decision-making and readiness for treatment, and advocate patient wishes within multidisciplinary settings,” wrote the authors. They pointed out, however, that it is unclear whether these LCNS working practices are independently linked to treatment uptake by patients, with a paucity of research on the topic.
Thus, the investigators conducted this study to analyze whether variables mediating LCNS workload are correlated with receipt of treatment—particularly surgical treatment—in an English population.
Using national databases, they identified and analyzed data from 109,079 patients with lung cancer who were diagnosed between 2007 and 2011 and survived 30 days. In sum, 31.8% received no cancer therapy, 33.9% received chemotherapy, 18.3% received radiotherapy, and 16.1% received surgery.
The investigators employed multinomial logistic regression to figure adjusted relative risk ratios (RRRs) for patient receipt of anticancer therapies correlated with the following: LCNS assessment, LCNS workforce composition, caseload, LCNS-reported working practices, treatment facilities at the patients’ hospitals, and the census of the lung cancer service.
The authors found that LCNS patient assessment was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments most notably correlated with greater receipt of surgery (RRR: 1.85, 95% CI: 1.63-2.11). Furthermore, for patients who were considered clinically suitable for surgery, receipt of this treatment was 55%.
They also noted that large LCNS caseloads were correlated with reduced receipt of surgery among eligible patients (> 250 vs ≤ 150 new and surviving patients).
Dr. Stewart and colleagues suggested that one way to alleviate LCNS caseload pressure may be to delegate routine administrative tasks to clinical support workers and care coordinators, thus allowing the LCNS ample time to make well-informed treatment decisions. Reduced caseload pressure could also allow the LCNS to spend more time addressing patient concerns about treatment risk.
“LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy,” the authors concluded. “Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable.”