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Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england.

Published on Jun 1, 2016in Lung Cancer4.599
· DOI :10.1016/j.lungcan.2016.03.011
Aamir Khakwani8
Estimated H-index: 8
(University of Nottingham),
Richard Hubbard72
Estimated H-index: 72
(University of Nottingham)
+ 5 AuthorsLaila J. Tata31
Estimated H-index: 31
(University of Nottingham)
Sources
Abstract
© 2016 Published by Elsevier Ireland Ltd.Background: Lung cancer nurse specialists (LCNS) are integral to the multidisciplinary clinical team, providing personalised physical and psycho-social interventions, and care management for people with lung cancer. The National Institute of Health and Care Excellence (NICE) recommend that all patients have access to a LCNS. We conducted a national study assessing whether there is variation in access to and timing of LCNS assessment. Methods: The National Cancer Action Team's LCNS workforce census in England was linked with patient and hospital Trust data from the English National Lung Cancer Audit. Multivariate logistic regression was used to assess features associated with LCNS assessment. Results: 128,124 lung cancer patients were seen from 2007 to 2011. LCNS assessment confirmation was 'yes' in 62%, 'no' in 6% and 'missing' in 32%. Where (in clinic versus ward) and when (before versus after diagnosis) patients were assessed by a LCNS also varied. Older patients with poor performance status, early cancer stage, and comorbidities were less likely to be assessed; there was no difference with sex or socioeconomic group. Patients receiving any anti-cancer treatment were more likely to be assessed. Assessment was lower in Trusts with high annual patient numbers (odds ratio = 0.58, 95% confidence interval 0.37-0.91) and where LCNS caseload > 250 (0.69, 0.41-1.16, although not statistically significant), but increased where workload was conducted mostly by band 8 nurses (2.22, 1.22-4.02). Conclusion: LCNS assessment varied by patient and Trust features, which may indicate unmet need for some patients. The current workforce needs to expand as well as retain experienced LCNSs.
  • References (13)
  • Citations (6)
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References13
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#1Aamir Khakwani (University of Nottingham)H-Index: 8
#2Anna L Rich (University of Nottingham)H-Index: 10
Last. Richard Hubbard (University of Nottingham)H-Index: 72
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Objectives To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC). Design Cross-sectional study from individual patients, between 1January 2008 and 31March 2012. Setting Linked National Lung Cancer Audit and Hospital Episode Statistics datasets. Participants 95 818 English patients with a diagnosis of NSCLC, of whom 12 759 (13%) underwent surgical resection. Main outcome me...
20 CitationsSource
Clinical nurse specialists (CNS) in cancer perform a range of complex activities, including the management of care. However, they often report a high administrative burden for services, which makes providing expert nursing care challenging. Administrative work for a service can be seen as a priority for non-nurses, yet a high administrative burden allows less time for complex nursing care. A London trust admitted a mean of four lung cancer patients per month for symptom control in progressive di...
7 CitationsSource
#1Aamir Khakwani (University of Nottingham)H-Index: 8
#2Anna L Rich (University of Nottingham)H-Index: 10
Last. Richard Hubbard (University of Nottingham)H-Index: 72
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Background: The purpose of this study was to identify trends in survival and chemotherapy use for individuals with smallcell lung cancer (SCLC) in England using the National Lung Cancer Audit (NLCA). Methods: We used data from the NLCA database to identify people with histologically proven SCLC from 2004–2011. We calculated the median survival by stage and assessed whether patient characteristics changed over time. We also assessed whether the proportion of patients with records of chemotherapy ...
19 CitationsSource
#1Aamir KhakwaniH-Index: 8
#2Anna L RichH-Index: 10
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Lung cancer survival in England: trends in non-small-cell lung cancer survival over the duration of the National Lung Cancer Audit
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#2Laila J. Tata (Nottingham City Hospital)H-Index: 31
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82 CitationsSource
#1Aamir Khakwani (University of Nottingham)H-Index: 8
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Abstract Background The National Lung Cancer Audit (NLCA) recommends that trusts obtain pathology (histology or cytology) for 75% of their lung cancer patients, however this figure was arbitrarily chosen and the optimal pathological confirmation rate is unknown, and many countries report somewhat higher rates. The aims of this study were to provide a simple means of benchmarking appropriate pathological confirmation rates by stratifying patients into groups, and whether obtaining pathology based...
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#1Paul BeckettH-Index: 5
#2I WoolhouseH-Index: 6
Last. L DarlinsonH-Index: 1
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Introduction Lung cancer nurse specialists (LCNS) provide an extremely important service to patients. Their skill and expertise are valued very highly by both patients and colleagues, but it has proven difficult to measure their input objectively, leading to a lack of expansion (and in some areas contraction) of the workforce. Earlier this year the National Lung Cancer Audit (NLCA) reported that for 2009, patients who saw an LCNS were more than twice as likely to receive active anti-cancer treat...
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58 CitationsSource
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