NICE guidelines for the diagnosis and treatment of lung cancer.

Access to service
Lung cancer clinical nurse specialists can obtain useful support and advice about patient information and lung cancer campaigning from the Roy Castle Foundation. In addition, November 2005 will be designated Global Lung Cancer Awareness Month.

A patient information booklet has been developed by NICE to complement the new guidance that will inevitably empower patients and lead to raised expectations.

Diagnosis
This guideline is not considered to be within the role of nurses, although the provision of a fail-safe chest X-ray tracking system was originally developed by lung cancer clinical nurse specialists. Further details can be found in Integrating Lung Cancer Nursing: A good practice guide (DoH, 2004).

Staging of lung cancer
Because the limited numbers of positron emission tomography (PET) scanners in the UK are not distributed evenly across the country, it is inevitable that patients and their carers will be asked to travel lengthy distances in order to access a PET scan. However, the benefits to the quality of treatment are such that the resulting level of inconvenience to patients and cost to health-care providers are, in comparison, of little consequence. The support, negotiation, co-ordination and service redesign required on behalf of patients to meet this priority will undoubtedly require significant involvement from lung cancer clinical nurse specialists.

Palliative interventions
Lung cancer clinical nurse specialists recognise the benefits of non-drug interventions for breathlessness and, where manpower resources are sufficient, many have developed such services. Further details can be found in Integrating Lung Cancer Nursing: A good practice guide (DoH, 2004).

Service organisation
In many centres, the lung cancer clinical nurse specialist meets patients after they have received their diagnosis. In addition, the nurse is now clearly expected to become involved and support patients and their carers through the referral and diagnostic stage of their journey. This will undoubtedly have significant resource implications for the number of lung cancer clinical nurse specialist posts.

Moore et al (2002) provide the supporting evidence for the option of a nurse-led follow up service. When treatment is completed nurses are well placed to discuss and assess a patient's preferences for follow-up and to prepare an individual plan.

Many centres provide early diagnostic medical clinics and the option of nurse co-ordinated diagnostic clinics is beginning to emerge.

The provision of smoking cessation advice for patients is an important issue for all nurses. Such programmes are widely available throughout the NHS. However, when patients have a diagnosis of lung cancer they may feel acutely burdened with being offered options and information knowing they have a poor prognosis and are receiving treatment and care. Perhaps the lung cancer clinical nurse specialists should, at this stage, highlight the advantages of smoking cessation and signpost smoking cessation services.

At a local level, achieving patient satisfaction with lung cancer care has been widely accepted as being the responsibility of lung cancer clinical nurse specialists. The National Lung Cancer Forum for Nurses has acknowledged this and, in response, has established a working group with the aim of developing some useful patient satisfaction tools for nurses to adapt for use within their own centres.

Conclusion
The role of lung cancer clinical nurse specialists is fundamental to the provision of a quality service for people with lung cancer. Nurses develop close, professional, caring relationships with their patients and will continue to be pivotal in ensuring services are tailored to meeting individual patients' needs and preferences. It is hoped that there will be a national funding initiative to support lung cancer clinical nurse specialists to develop their services in line with the NICE guidelines. Further information
The National Lung Cancer Forum for Nurses has over 200 members and was established in 1999 primarily to provide education, networking and support for lung cancer nurses. Membership details can be found on: www.nlcfn.org.uk

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