Study: Lung Cancer Nurse Specialists’ Impact on Anticancer Treatment

A recent study published in the journal Lung Cancer evaluated the effects of lung cancer nurse specialists (LCNSs) on anticancer treatment, specifically how service factors, LCNS workload, and LCNS working practices impact patients’ receipt of treatment. 

Researchers used national English databases to gather data on 109,079 lung cancer patients diagnosed between 2007 and 2011 who survived 30 days from diagnosis, and they collected LCNS workforce information. Of the lung cancer patients, 31.8% did not receive anticancer therapy, 33.9% received chemotherapy, 18.3% received radiotherapy, and 16.1% received surgery. 

Study shows that the working practices of lung cancer nurse specialists (LCNSs) in the United Kingdom improved anticancer therapy uptake rates. #LCSM https://t.co/DD2d17CIRy

— IASLC (@IASLC) October 22, 2018

Patients who were assessed by an LCNS had an increased relative risk ratio (RRR) of anticancer therapy compared with patients who did not receive an assessment (surgery RRR 1.98, chemotherapy RRR 2.18, radiotherapy RRR 1.84 after adjustments). LCNS assessment before or at the time of diagnosis was associated with an increased RRR among all anticancer therapies compared with assessment after diagnosis, most notably for surgery patients (surgery RRR 1.85, 95% CI 1.63–2.11). 

A reminder of the global importance of lung cancer in overall mortality #ESMO18 pic.twitter.com/l6pVdpwkua

— David Woolf (@ClinOncologist) October 22, 2018

Workforces with a Band-8 LCNS were less likely to offer patients chemotherapy (RRR 0.73, 95%CI 0.54–0.97). Average caseloads of > 250 patients/LCNS were correlated with an increased RRR for radiotherapy (RRR 1.26, 95% CI 1.00–1.59). 

Patients treated at specialist anticancer treatment facilities were more likely to receive anticancer therapy across all three groups, with the presence of surgical facilities yielding the highest associations (surgery RRR 1.80, chemotherapy RRR 1.81, radiotherapy RRR 1.47 after adjustments). When specialist chemotherapy facilities were available, patients were more likely to receive chemotherapy (RRR 1.39, 95% CI 1.10–1.75) and radiotherapy (RRR 1.27, 95% CI 1.05–1.53), but no correlation was observed for surgery. 

Overall survival benefit in consolidating all sites of metastatic disease in setting of NSCLC. Game changer by Dr. Daniel Gomez of @MDAndersonNews given that 50% of lung cancer patients present as Stage IV @ASTRO_org pic.twitter.com/ty74eXjFtX

— Dario Pasalic, MD (@Dario_Pasalic) October 21, 2018

The study authors concluded, “We propose that enabling and supporting LCNSs to undertake key case-management duties, whilst monitoring WTE working hours relative to manageable caseload sizes, could reduce workload pressures sufficiently to improve treatment uptake in all lung cancer diagnoses, highlighted in those who are clinically suitable. Future studies should further elucidate patient reasons for refusal of optimal treatment strategies.” 

Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy? 

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Source: Lung Cancer