1. End of Life Care in Lung Cancer: Lessons learnt through the Lung Cancer Pathways and Practices
Jane E Scullion
Respiratory Nurse Consultant
University Hospitals of Leicester

2. To cover What works well? What doesn't work so well?
Where are there similarities?
What are the learning points?

3. Background: Lung Cancer
Lung cancer the UK’s biggest cancer killer 1:5 of all cancer deaths
35,371 deaths pa
44,488 new cases per annum (2012)
(24,005 men 20,483 women) (2012)
Compared to the European average, cancer survival in England is low 5% at ten years
Late presentation
34% of all lung cancer patients in UK currently diagnosed as an emergency

4. Background: COPD 1.2 million people with COPD (2% of the population)
COPD deaths per annum 28-30,000
UK in top 20 countries for COPD mortality world wide In Europe only Denmark and Hungary have higher death rates. However UK lower than US and New Zealand
115,000 New Cases pa diagnosis very five minutes
10% more males than females
15% due to workplace exposure = 4,000 deaths pa
(HSE Oct 2015)
26% die within a year of diagnosis
34% of all COPD admissions are undiagnosed at admission

5. Shared problems Stigma Lack of understanding of signs and symptoms
Often frequent consultations before diagnosis so worse experience of care and potentially worse outcomes (BLF)
Old age
Social deprivation

6. Shared problems Nihilism Lack of investigation Co-Morbidity
Training and Education of HCP
Risk stratification - lifestyle clinical history

7. Supported by an MDT approach and Lung Cancer Nurse Specialists
Lung Cancer pathway CT
Primary
Care
Urgent
Referral
First Specialist
Assessment
Decision to treat
First Treatment
Supported by an MDT approach and Lung Cancer Nurse Specialists
Set within a time scale

8. Diagnostic Pathway Lung Cancer
Prevention
Screening
Diagnosis
Recovery
Treatment
Palliation /EOL

9. Diagnostic Pathway Lung Cancer
Prevention
Screening
Diagnosis
Recovery
Treatment
Palliation /EOL

10. Diagnostic Pathway Lung Cancer
Prevention
Screening
Diagnosis
Recovery
Treatment
Palliation /EOL

11. Diagnostic Pathway Lung Cancer
Prevention
Screening
Diagnosis
Recovery
Treatment
Palliation /EOL

12. Diagnostic pathway Lung Cancer
Prevention
Screening
Diagnosis
Recovery
CNS
Treatment
Palliation /EOL

13. Diagnostic Pathway: COPD
Prevention
Screening
Diagnosis
Stability
Treatment
Palliation /EOL

14. Or
Stability
Prevention
Treatment
Diagnosis
Palliation /EOL
Screening

15. Prevention
Smoking Cessation
Workplace surveillance

16. Screening Risk stratification - lifestyle clinical history
Direct access for tests
Linked up communication / records

17. Diagnosis

18. Patient experience Unnecessary investigation Poor symptom management
Lack of recognition of end of life
Delays in discharge
Inadequate communication

19. ELCWP Develop recommendations to address late diagnosis
Improve outcomes
Best possible treatment and care
Access to specialist nurses - key members of the MDT support for patients and coordination

20. Best practice Awareness Smoking status CXR Follow up
Investigation and referral
Template
Audit

21. Learning points

22. Learning points