Management

Clinical treatment

Lung cancer treatment varies based on the location of tumours, subtype of lung cancer, and the stage of the disease at diagnosis. Treatment approaches may include:

• Surgery
• Radiofrequency ablation
• Radiation therapy
• Systemic drug therapy
• A combination of the above.

Genetic testing results may also determine if systemic treatment can consist of chemotherapy, immunotherapy, targeted therapy or a combination. The intent of treatment can also differ, ranging from curative to palliative care or symptom management, depending on the patient’s and treating team’s goals.

You can access patient information on lung cancer medications through the Cancer Institute NSW eviQ website.

Supportive care and survivorship

Patients with lung cancer have diverse care needs across physical, psychological, social, informational, spiritual, and practical aspects. These are known as supportive care needs, and it’s essential to screen for and address them appropriately. When these needs are met, patients typically experience decreased distress, increased satisfaction with care, and are more likely to adhere to treatments and clinician recommendations.

Primary care physicians and nurses are ideally positioned to identify and respond to supportive care needs due to accessibility, familiarity with patients and their families, and broad scope of practice. Patients in regional, rural and remote areas particularly rely on primary care clinicians for supportive care. It’s also important to consider and address the needs of caregivers and families.

Assess patients with lung cancer and their caregivers for supportive care needs at key points in their care, including:

• Initial presentation or at diagnosis
• At the start of treatment or when treatment changes
• When a patient’s prognosis changes
• When treatment has ended
• During survivorship
• If lung cancer recurs
• At a change in or development of new symptoms
• When patients experience any significant change in their personal circumstances, such as caregiver illness or a change in household finances.

Supporting lung cancer patients in their recovery is essential, and a survivorship care plan can make a big difference. This important document helps patients navigate life after diagnosis by providing a personalised summary of their condition, treatment history, and next steps. It outlines follow-up care, potential side effects to watch for, and practical ways to maintain health and well-being. Primary care doctors and nurses play a key role in creating this plan, ensuring patients get the guidance they need to move forward with confidence. Link to survivorship care.

Discussing support care with patients

While supportive care needs vary based on factors like prognosis and stage in the cancer care continuum, primary care health professionals should, at a minimum, consider:

• Practical support needs: Does your patient have issues with transport or mobility? Would your patient prefer a telehealth appointment if appropriate? Does your patient have a fixed or reduced income? Are there ways you can reduce the cost of prescribed medications or supportive care referrals?
• Physical support needs: Does your patient have a Chronic Disease Management Plan to address physical symptoms and treatment side effects? Do they need referrals to exercise physiologists, respiratory physiotherapists, pulmonary rehabilitation, speech pathologists, or other allied health services? Would your patient benefit from a referral to palliative care to manage symptoms or side effects, or because treatment has ceased?
• Psychological support needs: Does your patient require a Mental Health Treatment Plan to address or prevent anxiety and depression?
• Social support needs: Does your patient live with caregivers or family who need to be involved with treatment delivery and planning? Do they have other social supports they can access? Is your patient’s caregiver coping, and how can they be best supported?
• Information support needs: Does the patient understand their diagnosis and treatment plan, and how to communicate symptoms and side effects as they arise? Identify and address any gaps in their understanding and consider referring them to the Lung Cancer Specialist Nurse and the suite of lung cancer resources.
• Practical support needs: Does your patient have issues with transport or mobility? Would your patient prefer a telehealth appointment if appropriate? Does your patient have a fixed or reduced income? Are there ways you can reduce the cost of prescribed medications or supportive care referrals?

Optimal care pathways

Optimal cancer care pathways (OCPs) outline best practice cancer care throughout the patient’s experience. They aim to foster an understanding of the entire pathway and its components to promote quality lung cancer care and optimal patient experiences. OCPs are implemented nationally and are available for many cancers, including lung cancer.

OCPs are based on several key principles of care:

• Patient-centred care: Care that respects and responds to the needs, wishes and values of patients.
• Safe and quality care: Achieved through appropriately trained and credentialled clinicians, and effectively resourced and evaluated hospitals and clinics.
• Multidisciplinary care: An integrated team approach where medical and allied health professionals consider all relevant treatment options and collaboratively develop an individual treatment and care plan for each patient.
• Care coordination: To achieve continuity of care for patients, ensuring care is delivered in a logical, connected, and timely manner to meet the patient’s medical and personal needs.
• Communication: Ensuring patients, their families, and carers can communicate effectively with clinicians and care providers throughout their lung cancer treatment and survivorship.
• Research and clinical trials: Participation should be offered to patients at any stage of the care pathway, as they play an important role in establishing the efficacy and safety for a range of treatments, and identify benefits around psychological, supportive, and palliative care interventions.
• Supportive care: Services that lung cancer patients may require during their treatment and survivorship to address varied and changing needs.

The OCP also clearly outlines how your patient’s leading lung cancer management clinician should communicate with your patient and with primary care professionals to ensure a team approach to treatment and management. View the resource

Lung cancer multidisciplinary teams

The Multidisciplinary Team (MDT) is a group of expert medical and allied health professionals from various specialties who meet to collaboratively develop and review treatment plans for cancer patients. The team considers patients’ personal preferences and individual supportive care needs.

Referring your patient to a specialist affiliated with a lung cancer multidisciplinary team (MDT) is crucial for ensuring they receive evidence-based lung cancer care from an early stage. Cancer Australia guidelines emphasise the importance of rapid referral of patients with suspected or proven lung cancer to a hospital and specialist linked with a lung cancer MDT service. 

The MDT approach is best-practice care in cancer management, demonstrating improved survival rates and patient satisfaction while delivering quality care aligned with evidence-based guidelines. The MDT approach also provides coordinated care and offers information and support for patients.

Lung Foundation Australia’s directory of dedicated lung cancer MDTs helps health professionals locate these teams and access contact and referral information.

Clinical resource hub

The clinical and supportive care needs of your patients will vary depending on their treatment plan. The following resources will help you provide the best clinical management and supportive care for your patients, their families, and caregivers throughout treatment and survivorship:

• Clinical practice guidelines for the treatment of lung cancer
  These guidelines from 2017, were commissioned and co-funded by Cancer Australia and developed by Cancer Council Australia
• Delivering best practice lung cancer care: a summary for health professionals
  An overview of the Lung Cancer Framework, focusing on five key principles.
• Lung Cancer Framework
  An evidence-based resource for best practice lung cancer management in Australia.
•  Best practice management of lung cancer
  A 2.25-hour online course covering lung cancer pathophysiology, needs, and treatment approaches.
• The important role of general practice in the care of cancer survivors
  Highlights the GP’s role in survivorship care and common concerns of cancer survivors.
• Survivorship care in general practice: supporting patients to live well
  Guidance for primary care clinicians supporting patients following cancer treatment.
• Supporting health professionals to deliver optimal survivorship care
• Resources for health professionals providing care to cancer survivors, including developing survivorship care plans.