A new study presented today has unmasked concerning inequities and inconsistencies in Victoria’s diagnosis and treatment of lung cancer, with notable variation in practice between public and private hospitals and metro and regional centres.
Poor adherence to clinical guidelines and delays in getting people to treatment are also common.
The results are being presented for the first time at Lung Foundation Australia’s 2020 Australian Lung Cancer Conference (ALCC) at the Melbourne Convention Centre from 19-21st February.
“If you’re a Victorian diagnosed with lung cancer today, the quality of care you receive and therefore your chances of survival might be heavily influenced by whether you live in the city or the country, your age, or if you have public or private health care,” explains Lung Foundation Australia CEO Mark Brooke.
“The findings of this study could have serious implications not just for Victoria but for Australia as a whole,” he said.
The Victorian Lung Cancer Registry (VLCR), based at Monash University’s School of Public Health and Preventive Medicine, is Australia’s first state-wide initiative to measure and benchmark quality of care in newly diagnosed lung cancer patients. The aim is to identify clear actionable targets for quality improvement. It has been running since 2011.
In 2018, 2117 newly diagnosed patients from 44 hospitals and 19 health services were placed on the Registry, capturing 85 per cent of new cases in Victoria.
Some of the variations identified include:
Time from diagnosis to treatment: Patients in private care are three times more likely to be on treatment within 14 days after diagnosis (78 per cent) than regional patients (26 per cent) and almost twice as likely as patients in the public health system (41 per cent). The importance of this was highlighted by another study at the conference, which showed that early-stage patients with the most common form of cancer (NSCLC) who start treatment within 14 days live longer than those treated after more than 14 days.
Time from referral to treatment: 61 per cent of private patients in 2018 received treatment within 42 days of referral, as opposed to just 26 per cent of public patients and 32 per cent of regional patients.
Age: Compared to younger patients, elderly patients diagnosed with advanced-stage lung cancer were found to a have a four-fold lower likelihood of active treatment and disproportionately higher mortality (26.9 per cent), even after adjusting for confounders. This is associated with them being less likely to be prescribed treatments, even when their general health is equivalent to younger patients.
Poor adherence to clinical guidelines across all services: All health services are doing a poor job of adhering to clinical guidelines, particularly in terms of offering supportive care assessments, which should take place regularly to ensure lung cancer patients are receiving the social, psychological and pastoral support they require. Participation in Multi-disciplinary Care Meetings (MDM), similarly designed to provide optimal access to care and to the most appropriate treatment, was also low.
According to VLCR Clinical Lead & Steering Committee Chair A/Prof Robert Stirling, much of this variation in practice could be due to the absence of available, trained specialist lung cancer nurses (SLCN).
“The presence of a specialist lung cancer nurse at diagnosis is a key quality indicator in the UK. They are considered essential to communication, continuity and coordination; helping the patient and their family understand their cancer and treatment options and ensuring they receive appropriate initial treatment and long-term follow-up. But here in Australia we have the full time equivalent of just 12 specialist lung cancer nurses to take care of the more than 12 800 new patients diagnosed each year,” he said.
This is in stark contrast to the more than 450 cancer nurses for breast and prostate cancer.
Researchers say the Registry identifies clear actionable targets for quality improvement.
“Across the board, there’s a lot we need to do,” says A/Prof Stirling.
“We need to get better at identifying the psychosocial and distress support needs of our patients.
“We need to do more to ensure that our patients are being discussed in MDM and have the support of a specialist lung cancer nurse, as per clinical guidelines.
“We need to get people on treatment faster.
“And we need to address inequities to ensure that all Australians have equal access to high-quality lung cancer care,” he said.
The results of this study reconfirm the inequities that Australians diagnosed with lung cancer are facing,” Mr Brooke said.
“Despite being our nation’s biggest cancer killer, there is limited investment into dedicated research and no funding to increase the workforce capacity of specialist lung cancer nurses. We know access to a specialist cancer nurse improves outcomes by 34 per cent so it’s time our government starts giving Australians diagnosed with lung cancer a fair fight.”
On Wednesday 19th February 2020 Lung Foundation Australia launched a petition calling on the federal government to fund 15 specialist lung cancer nurses in this year’s budget. Signatures are being collected from the general public as well as healthcare professionals and presented to the House of Representatives in March.
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