Case studies lung cancer patients

Lacher planned monthly lunch and learns for physicians and nurses. Sanford also integrated a flagging system for LCS eligibility within the electronic medical record EMR so physicians could more easily identify high-risk patients. The lunch and learns also gave referring physicians an opportunity to ask questions and voice their concerns. Some referring physicians worried that the radiologists wanted to commandeer their patients. But Kearns and Lacher assured them that the goal was to work collaboratively to provide this enhanced patient care.

Lung Cancer: A Case Study

Still, many PCPs felt ill-equipped to manage the increasing volume of lung nodule patients that screening would identify. N Engl J Med; Van Ells, M. Smoking Ban to Change Bar Culture. How does that compare to state and national levels? What percentage of your patient population is eligible for lung cancer screening? How many lung cancers are detected in your community?

Lung Screening Solutions | American College of Radiology

How many are detected at Stage 4 vs. How do these numbers compare to state and national levels? Which care providers can you partner with to develop a lung cancer screening program? What additional staff do you need to support your program? How can you fund these positions? The PS determines the patient's general well-being.

Background

Patients are usually fit for active treatment if the PS is less than two. The score aims to quantify a patient's fitness for day-to-day activities, so general practice is a good setting for this. In cases of poor PS, significant comorbidities, patient preference, or where further investigation is contraindicated or inappropriate, a radiological diagnosis may be acceptable. In patients where treatment is indicated, radiological diagnosis is insufficient and histological confirmation of malignancy will be necessary.

The goal of these initial investigations is to choose a site for biopsy that will provide the most clinical information on diagnosis and staging, with the least risk to the patient. Tissue can be obtained by different techniques based on findings from radiological investigations.

Combining Trial Data With Clinical Case Studies to Illustrate the Lung Cancer Landscape

The sampling target should be the lesion that will establish the highest disease stage, assuming it is not inaccessible and the sampling procedure does not pose a particularly high risk to the patient for example, brain metastasis. Invasive investigations can include sampling of supraclavicular lymph nodes, aspiration of pleural effusion, bronchoscopy and associated techniques, such as biopsy, brushings, washings, blind transbronchial needle aspiration TBNA , endobronchial ultrasound EBUS guided TBNA, CT guided transthoracic needle aspiration, oesophageal ultrasound guided aspiration, mediastinoscopy and thoracotomy.

EBUS has now become the first-line investigation of choice for diagnosing and staging presumed lung cancer with associated mediastinal adenopathy or central tumours. A randomised controlled study, published in , showed a significantly reduced time from investigation to treatment decision versus conventional flexible bronchoscopy. For example, a patient whose chest CT reveals a left upper lobe mass with right paratracheal lymph node enlargement should have the lymph nodes sampled.

Important Endobronchial ultrasound is the first-line investigation for diagnosing and staging presumed lung cancer with associated mediastinal adenopathy or central tumours. All patients with suspected lung cancer should be referred to a chest physician under the two-week wait rule.

Cases of confirmed malignancy should be discussed at a multidisciplinary team meeting consisting of a chest physician, thoracic surgeon, medical and radiation oncologist, radiologist and histopathologist. In cases where active treatment is indicated, for example in patients with adequate PS and without significant comorbidities, the choice of treatment is based on tumour histology and disease stage.

The stage will also dictate whether the treatment is radical or palliative. More advanced stage confirmed after initial surgical resection may benefit from adjuvant chemotherapy, depending on the final pathological stage. More advanced surgery, including bilobectomy, pneumonectomy, sleeve resections resections aiming to preserve functioning lung and chest wall resections should be offered if clear resection margins can be obtained.

An alternative treatment approach to surgery is radiotherapy, which can be offered to patients who are unsuitable for surgery. Stereotactic radiotherapy, as opposed to standard external beam radiotherapy, uses focused beams of radiotherapy in fewer treatment fractions to more accurately target the tumour. In more advanced disease, combined chemoradiotherapy may be appropriate. It is common practice to evaluate for mutations in epidermal growth factor receptor EGFR and anaplastic lymphoma kinase ALK in patients diagnosed with adenocarcinoma of lung origin.

In advanced disease, chemotherapy prolongs survival and improves quality of life, and may provide palliation for local symptoms. SCLC is an aggressive malignancy that progresses rapidly. About two-thirds of patients present with extensive disease. Patients with limited disease, defined as disease involving one hemithorax, are treated with a combination of chemotherapy and radiotherapy because it has been shown that the addition of radiotherapy improves survival.

Extensive stage SCLC is treated with chemotherapy alone. The brain is often the site of initial relapse and prophylactic cranial irradiation has been shown to decrease the incidence of brain metastases and to prolong the patient's survival. SCLC is a chemosensitive malignancy, with response rates of up to 85 per cent. Unfortunately disease relapse is common. There are a number of options for relieving symptoms secondary to central airway obstruction, including laser, cryotherapy, brachytherapy, tumour debulking and stent placement.

Abstract Patient navigation has been proposed to combat cancer disparities in vulnerable populations. There were no differences in screening rate between the types of navigation. References 1.

Ken’s story

Shivayogi P. Vulnerable population and methods for their safeguard. Perspect Clin Res ;— Waisel DB. Vulnerable populations in healthcare. Curr Opin Anaesthesiol ;— Rebbeck TR. Defining priorities for reducing disparities in cancer mortality. Cancer Epidemiol Biomarkers Prev ;— Health disparities and health equity: the issue is justice.

Most Popular

Institute of Medicine. Washington, DC: Institue of Medicine, Google Scholar 6. Singh GK , Jemal A. J Environ Public Health ; Google Scholar 8.

Dohan D , Schrag D. Using navigators to improve care of underserved patients. Cancer ;— Reducing disparities in the burden of cancer: the role of patient navigators.

PLoS Med ;3:e Freeman H. A model navigation program. Oncol Issues ;— Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract ;— Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. J Am Coll Surg ;— Freeman HP. Patient navigation: a community based strategy to reduce cancer disparities.

J Urban Health ;— The history, principles, and future of patient navigation: commentary. Semin Oncol Nurs ;— National Cancer Institute. Google Scholar Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med ;— Patient navigation: state of the art or is it science? Jemal A , Fedewa SA. Lung cancer screening with low-dose computed tomography in the United States to JAMA Oncol ;— American Cancer Society. Scientific advances in thoracic oncology J Thorac Oncol ;— J Health Soc Behav ;— Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana long-term smokers.

Prev Med Rep ;— The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol ;— Personal navigation increases colorectal cancer screening uptake. Implementation of a lung cancer nurse navigator enhances patient care and delivery of systemic therapy at the British Columbia cancer agency, Vancouver. J Oncol Pract ;e—e A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities.

J Natl Med Assoc ;— Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation. J Am Geriatr Soc ;— Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Med ;— A culturally tailored navigator program for colorectal cancer screening in a community health center: a randomized, controlled trial.

J Gen Intern Med ;— Patient navigation for colonoscopy completion: results of an RCT. Am J Prev Med ;— Patient navigation for comprehensive cancer screening in high-risk patients using a population-based health information technology system: a randomized clinical trial. Increasing colonoscopy screening for Latino Americans through a patient navigation model: a randomized clinical trial.

J Immigr Minor Health ;— Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med ;— Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial. J Am Board Fam Med ;— Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev Med ;— Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial.