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Reduction in access to lung cancer nurse specialists

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Latest figures indicate there has been a fall in access to lung cancer specialist nurses, warn respiratory experts.

In 2014, access to lung cancer nurse specialists “appears to have fallen”, according to the latest national audit on services for the condition – the second most common cancer in the UK.

Of patients diagnosed in 2013, 84% were seen by a specialist nurse, but in the 2014 cohort, only 78% were seen, said the audit report, which was published yesterday by the Royal College of Physicians.

But nine organisations told that auditors that fewer than 25% of their patients saw a lung cancer specialist nurse, which they said raised the possibility that “data completeness may be an issue”.

Similarly, only 87% of cases had a clear “yes” or “no” on whether the patient was seen, and it is likely that some of the remaining 13% of patients were in fact seen.

It suggested that the overall figure of 78% may be an underestimate, acknowledged the auditors.

As in previous years, they highlighted the positive association between access to nurse specialists and receipt of anti-cancer treatment.

lung cancer

For example, in 2014, 63.6% of lung cancer patients who saw a specialist nurse received anti-cancer treatment, compared with 24.6% of those who did not see one.

The proportion of patients who should be seen by a nurse specialist “continues to be a source of debate”, noted the auditors, with some feeling that the bar is currently “set too high”.

As a result, as part of the audit, the National Lung Cancer Forum for Nurses carried out a survey of its members in 2015.

They asked members whether it was “feasible” to have a new indicator in the annual audit that 90% of patients should be seen by a lung cancer specialist nurse.

“The responses were mixed, but 59% felt that it was feasible,” said this year’s audit report.

The report added: “Overwhelmingly, however, nurses felt that setting a challenging target was a good way to encourage investment in nursing expertise.”

Overall, the 11th annual report of the National Lung Cancer Audit revealed that, despite significant progress in lung cancer care during the first five years of the audit, very little has changed since then.

“Now is the time to take lung cancer care to the next level”

Ian Woolhouse

Surgery offers the best chance of a cure for lung cancer patients. However, the audit shows that since 2010, the proportion of lung cancer patients treated with surgery has not improved from 15%.

Furthermore, it can vary across the country from 10-24% and the difference does not appear to be due to the patients’ background, age or stage of lung cancer.

Dr Ian Woolhouse, senior clinical lead for the audit, said: “I am encouraged by the continued participation and support of the audit by lung cancer services across the country.

“However, now is the time to take lung cancer care to the next level by ensuring that all lung cancer patients receive the most up-to-date treatments so that the UK can achieve the outcomes currently reported internationally,” he said.

Participation in the audit by lung cancer services in England, Guernsey, Scotland and Wales was high, collectively contributing data on 37,000 patients diagnosed with the disease in 2014.

 Proportion of patients receiving active treatment (%)       
   2014  2013  2012  2011  2010 2009   2008
 Seen by lung cancer nurse specialist  63  65.6  66.6  65.3  64.4  64.8  59.4
 Not seen by lung cancer nurse specialist  24.5  27.1  27.4  28.7  29.8  30.4  30.6
 Data not recorded  48.2  35.4  39.7  44.8  44.8  52.6  51
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