Treatment of lung cancer depends on the location of tumours, the subtype of lung cancer detected and the stage at which the disease is diagnosed. Treatment approaches include surgery, radiofrequency ablation, radiation therapy, systemic drug therapy, or a combination of these options. Depending on genetic testing results, systemic treatment may consist of chemotherapy, immunotherapy, targeted therapy, or a combination of these treatments.
Patient information on lung cancer drug treatments can be accessed via the Cancer Institute NSW eviQ website.
Supportive care and survivorship
People living with lung cancer have care needs across the physical, psychological, social, information, spiritual and practical domains. These needs are referred to as supportive care needs, and it is important that they are screened for and addressed appropriately. When identified needs are addressed appropriately patients experience decreased distress, enhanced satisfaction with care, and are more likely to adhere with treatments and other clinician recommendations.
Primary care physicians and nurses are ideally placed to identify and respond to supportive care needs due to practice accessibility, clinician’s familiarity with patients and their families, and broad scope of practice. Patients in regional, rural and remote areas will rely most heavily on primary care clinicians to provide supportive care. It is important that the needs of caregivers and families are also considered and addressed appropriately.
Patients with lung cancer and their caregivers should be assessed for supportive care needs at key points of the care pathway3, including:
- Initial presentation, or at diagnosis
- At the commencement of treatment, or when treatment changes
- When a patient’s prognosis changes
- When treatment has ended
- During survivorship
- If disease recurs
- At a change in or development of new symptoms
- When patients experience any significant change in their personal circumstances, for example illness of caregivers or a change in household finances.
Considerations when discussing support care
While patients’ supportive care needs will differ according to various factors, including prognosis and stage in the cancer care continuum, at a minimum, primary care health professionals should consider:
- Physical support needs: Does my patient have a Chronic Disease Management Plan to address physical symptoms and side effects from their lung cancer and its treatment? Do they need referrals to exercise physiologists, respiratory physiotherapists, pulmonary rehabilitation, speech pathologists or other allied health? Would my patient benefit from a referral to palliative care to manage symptoms or side effects, or because treatment has ceased?
- Psychological support needs: Does my patient require a Mental Health Treatment Plan to address or prevent anxiety and depression?
- Social support needs: Does my patient live with caregivers or family members that need to be involved with treatment delivery and planning? Do they have other social supports that they can access for help and advice? Is my 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 gaps in patients’ understanding and refer your patient to the Lung Cancer Support Nurse.
- Practical support needs: Does my patient have issues with transport or mobility? Would my patient prefer a telehealth appointment if appropriate? Does my patient have a fixed or reduced income? Are there ways that I can reduce the cost of prescribed medications or supportive care referrals?
Optimal care pathways
Optimal cancer care pathways (OCPs) describe optimal cancer care across the patient journey, aiming to foster an understanding of the whole pathway and its distinct components to promote quality cancer care and optimal patient experiences. OCPs are implemented nationally and available for many different cancers, including lung cancer.
OCPs are based on several key principles of care, including the following:
- Patient-centred care – referring to 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 hospitals and clinics that are effectively resourced and evaluated.
- Multidisciplinary care – which provides an integrated team approach to healthcare in which 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, thereby ensuring that care is delivered in a logical, connected and timely manner so the medical and personal needs of the patient are met.
- Communication – to ensure that 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 efficacy and safety for a range of treatments, and identify benefits around psychological, supportive and palliative care interventions.
- Supportive care, which refers to services that lung cancer patients may require during their treatment and survivorship to address varied and changing needs.
The OCP also clearly outlines the ways that your patient’s leading lung cancer management clinician can be expected to communicate with your patient and with primary care professionals to work as a team in the treatment and management of their lung cancer.
Lung cancer multidisciplinary teams
Referring your patient to a specialist affiliated with a lung cancer multidisciplinary team (MDT) is one of the most important things you can do to ensure that your patient receives evidence-based lung cancer care from an early stage. Cancer Australia guidelines highlight 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 and has been shown to improve survival rates and patient satisfaction while delivering quality care in line with evidence-based guidelines. The MDT approach also provides coordination of care and provision of information and support for patients.
Lung Foundation Australia’s directory of dedicated lung cancer MDTs helps health professionals locate lung cancer MDTs and access contact and referral information.