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J.A. Rose



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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.06 - A retrospective study into the impact palliative care intervention had on place of death for patients diagnosed with non-small cell lung cancer between 2006 and 2011 in the Illawarra Shoalhaven Local Health District (ID 328)

      11:25 - 11:35  |  Author(s): J.A. Rose

      • Abstract
      • Presentation
      • Slides

      Background
      Between 01/01/2006 and 31/12/2011, 1070 cases of non-small cell lung cancer (NSCLC) were registered in the Illawarra Shoalhaven Local Health District (ISLHD) Clinical Cancer Registry (ClinCR); having been diagnosed and/or received a cancer directed treatment (including end-of-life palliative care) in an ISLHD public facility. A retrospective study was undertaken to determine the impact palliative care involvement had on the place of death for patients in this cohort who were known to be deceased.

      Methods
      A retrospective study was undertaken using data recorded in ClinCR. Data items include date of death, name of public facility where death occurred, palliative care status and date of referral to palliative care. Patients who did not die in public hospital had the place of death recorded in a free text box in ClinCR if it was documented in one of ISLHD’s electronic medical records: PowerChart, iPM, CHIME or MOSAIQ.

      Results
      Of the 1070 cases, 936 (87.5%) patients were known to be deceased, with 93% (872n) of those patients dying locally: palliative care facility 52% (454n); hospital 27.5% (240n); home 14.5% (127) and RACF 6% (51n). The remaining 7% died out of the Area (12n) or had “unknown” recorded for place of death (52n). 87% of those known to be deceased were referred to palliative care. Of the deceased patients not referred to palliative care, 45% died in an acute hospital, compared to 14% of those who were referred to palliative care. Home was the second most frequent place of death (15% 121n) for patients referred to palliative care.

      Conclusion
      This study shows the impact palliative care involvement had on the place of death for non-small cell lung cancer patients in ISLHD. Although more than 50% died in a dedicated palliative care ward/facility, the data shows that patients with palliative care intervention are more likely to die in their home, and less likely to die in an Acute Hospital. Patients with respiratory cancers may require hospital admissions due to local complications which may not occur in other cancers; making a comparison between this and another tumour stream a worthwhile exercise.

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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-040 - Analysis of why certain respiratory cancer patients diagnosed and/or receiving cancer directed treatment have repeat presentations at Multidisciplinary Team Meetings. (ID 2499)

      09:30 - 09:30  |  Author(s): J.A. Rose

      • Abstract

      Background
      Multidisciplinary team (MDT) meetings are seen as vital to delivering a coordinated approach to the care of patients who have been diagnosed with cancer. Use of an MDT model of care has been shown to increase patient recruitment to clinical trials, ensure a shortened patient journey from diagnosis to treatment, and result in a higher likelihood that the patient receives evidence-based treatment, ensuring better survival outcomes. Additionally, MDT’s are essential in ensuring correct diagnosis and staging, appropriate treatment modalities, and timely referrals to different disciplines within the team. The aim of this study was to analyse the reasons why respiratory cancer patients diagnosed within the Illawarra Shoalhaven Local Health District (ISLHD) have repeat presentations at MDT meetings.

      Methods
      Patients diagnosed with lung cancer (diagnosis included Small Cell Lung Cancer (SCLC), Non Small Cell Lung Cancer (NSCLC) and Mesothelioma) and discussed in the Lung Cancer MDT meeting in the ISLHD between 1st January 2006 and 31st December 2011 were identified. These identified patients were then cross-referenced against MDT meeting data stored in patient records. Patients identified as having been discussed more than once at an MDT meeting were analysed in relation to the documented reason for re-discussion.

      Results
      There were 533 patients presented in an MDT meeting within the six year period analysed. 463 were discussed once; 57 twice; 12 three times; and 1 four times. Of those discussed more than once, 10 had pathological diagnosis confirmed after the initial MDT presentation, and were re-presented to discuss these results and formulate a treatment plan. Of the 10 patients, reasons for presentation without pathological diagnosis included: non-diagnostic tissue sample or origin not specified (4); issues around comorbidities and most appropriate avenue for obtaining diagnosis (3); and protracted inpatient stay prior to pneumonectomy (1). Two patients were discussed prior to pathological diagnosis for no apparent reason. 31 cases were re-presented, as initial discussion recommended further investigation/staging. Of these, 18 had initial diagnosis/presumed stage confirmed, 8 were up-staged. After initial treatment was completed, 13 patients were rediscussed with regard to future treatment/monitoring, 10 due to an increase in symptoms and 15 due to disease progression. 50 of the cases discussed more than once resulted in the patient being referred to additional Specialists.

      Conclusion
      A review of five years of Lung Cancer MDT data has shown that the MDT meeting is performing its role as a central point for discussion of treatment options for lung cancer patients. In a small number of cases (1.9%) pathological diagnosis had not been confirmed prior to the MDT. For the majority of these patients (8), the meeting provided expert guidance in regards to the most appropriate timing and procedure to obtain tissue diagnosis. The MDT may benefit from the development of a template/pathway to ensure a reduction in the number of patients presented without pathological diagnosis and avoid discussion of some of the patients recommended for further investigation/staging. A template/pathway may enable the MDT to have a more complete picture of the patient’s diagnosis and reduce re-presentation/delays in treatment.