Too many lung cancer patients in the UK are missing out on “pivotal” support from a clinical nurse specialist, experts have warned.
They said lung cancer specialist nurses were “key” to improving the patient experience but found that access to these professionals was patchy around the nation.
“The lung cancer nurse specialist is really instrumental in opening doors to treatment”
“The roles of the lung cancer CNS are many and varied, but part of their role is to help in the co-ordination of services, to personalise the cancer pathway, and to inform and support the patient and their family,” the experts said.
“Therefore, the CNS is a critical member of the [multi-disciplinary team] who has a major impact on whether a patient has a positive experience of care,” they added.
However, they noted that latest data showed only 19% of trusts in England achieved the recommended standard of having one full-time lung cancer nurse per 80 new patients.
In addition, just 70% of patients had been seen by a lung cancer CNS throughout their pathway, against a target of 90%, and a little over half had a specialist nurse present at their diagnosis – the goal is 80%.
The figures were laid bare in a new report by the UK Lung Cancer Coalition (UKLCC) – titled Millimetres Matter (see attached PDF below) – which is calling for action to end “unwarranted” variations in treatment.
“Unwarranted delays in treatment can allow a tumour to grow by just a few millimetres which can have a dramatic effect on someone’s chance of survival”
The UKLCC claimed five-year survival rates for lung cancer patients in the UK were “consistently lagging behind” the rest of Europe. Out of 29 countries, Wales is ranked 28th, Scotland 27th, England 26th and Northern Ireland 19th.
Latest figures showed just 14% of males and 17.5% of females in England survived for five years after receiving a diagnosis of lung cancer, the report noted.
Patients diagnosed at the earliest stage of lung cancer were almost five times more likely to survive a year from diagnosis than those diagnosed in the later stages, yet just 27% of lung cancer patients in England were diagnosed in stage one or two.
In addition, under three quarters of patients recieved treated within the current 62-day national waiting time standard.
Lavinia Magee, nurse consultant in thoracic oncology at Papworth Hospital NHS Foundation Trust and a member of the National Lung Cancer Forum for Nurses committee, who contributed to the report, told Nursing Times that specialist nurses helped “speed up the pathway” for patients.
“The CNS is really pivotal at guiding the patient through the pathway as quickly and efficiently as possible to make sure they are given the time to make the right treatment decisions for them,” she added.
Ms Magee highlighted that lung cancer CNSs were essential to the UKLCC’s ambition to boost five-year lung cancer survival in the UK to 25% by 2025.
“The lung cancer nurse specialist is really instrumental in opening doors to treatment and getting access to the treatment,” she said.
“In different areas, in different hospitals, the lung cancer nurse specialists see patients at different points in their pathway, on multiple points in their pathway, and I think it’s just really key that the role of a lung cancer nurse specialist is absolutely recognised,” she said.
She added that the role of the CNS was to act as a “key worker” for patients and if possible to be their main contact throughout their care journey.
She noted that nurse specialists also helped to ensure patients were fit enough for treatment – which the UKLCC highlighted as a “crucial factor” in whether patients were able to undergo potentially curative interventions such as surgery.
However, Ms Magee said there was a “real shortage” of nurses with the right expertise and experience to apply for lung cancer CNS jobs.
More needed to be done to raise the profile of lung cancer nursing, said Ms Magee, adding that the profession was often seen as a “poor relation” to other fields such as breast cancer.
She warned that more funding was needed to enable trusts to develop these posts.
“The CNS has a major impact on whether a patient has a positive experience of care”
The UKLCC is calling for all cancer services in the UK to implement the National Optimal Lung Cancer Pathway, an NHS England initiative that advocates a standardised care pathway for lung cancer patients, wherever they live, as well as faster access to diagnostic tests and treatment and reduced waiting times.
Professor Mick Peake, chair of the UKLCC’s clinical advisory group, said: “Three out of four people with lung cancer are diagnosed too late to be suitable for potentially curative treatment.
“Unwarranted delays in treatment, even at the early stages, can allow a tumour to grow by just a few millimetres, which can have a dramatic effect on someone’s chance of survival,” he added.
Ms Magee has been a nurse since 1988 and has worked in lung cancer since 1997. Explaining why she loves the job, Ms Magee said: “It’s such a fantastic, varied role, and I think in the area that I work in we do see patients throughout their whole pathway.
“It’s challenging but very rewarding and I just love the job because I work with a great team which of course makes a huge difference and we are very research active,” she told Nursing Times.
”It’s just been fantastic over the past 20-plus years to see the developments that have been made in screening and diagnosing and treating lung cancer,” she said. “It is dynamic, it’s not stagnant, and no days are the same.”