Aim of the lung cancer case based learning resource
This case study aims to facilitate the development of competencies that reflect the role of the Specialist Cancer Nurse (SCN) in preventing and managing disease and treatment related care for a person at risk of or diagnosed with lung cancer.
In 2013, 11,174 Australians were diagnosed with lung cancer (6,627 males and 4,548 females).67 In 2014, lung cancer was the leading cause of cancer-related deaths for both men and women.67 The disease has one of the lowest five-year survival rates of all cancers, at 14.3% and accounts for about one in five deaths from cancer.5
In 2014, there were 8,251 deaths from lung cancer in Australia (4,947 males and 3,304 females). 6 The ten-year survival rate for lung cancer is only 9%.8
There are many points along the cancer journey when SCNs can improve outcomes for people at risk or affected by lung cancer. These include:
Section 1: Reduce risk
Between 1982 and 2011, the age-standardised incidence rate of lung cancer in males fell by 34% but rose by 42% in females.5 It is hypothesised that the differing pattern of lung cancer incidence is due to historical gender patterns of tobacco smoking.6
Tobacco smoking, a modifiable behaviour, is the most significant risk factor in the development of lung cancer. About 90% of lung cancer in men, and 65% in women, is attributed to smoking.7 Passive smoking— where someone is exposed to the chemicals in tobacco smoke, without actually smoking— can also cause lung cancer.7,8
Section 2: Find the condition early
While lung cancer has a high mortality rate, better prognosis is associated with early diagnosis.
Many people who are diagnosed late with incidental CXR findings have experienced persistent lung or other symptoms.9
Section 3: Have the best treatment and support during active treatment
There are many treatment options for lung cancer, including surgery, antineoplastic agents, drugs targeting oncogenic mutations, radiotherapy, brachytherapy, radiofrequency ablation, and laser therapy. The management approach depends on the type and stage of disease and individual patient factors. To achieve optimal outcomes, a multidisciplinary approach with support from specialist and primary care providers is required to ensure best practice treatments that improve survival rates and quality of life.
Management of the person with lung cancer requires a multifaceted approach. Symptom control and management of psychosocial issues are an important focus of care.
Section 4: Have the best treatment and support between and after active treatment
Depending on the type and stage of disease, people with lung cancer can be at a high risk of disease progression. People with lung cancer also often experience a range of symptoms, such as dyspnoea, pain, and nutritional deficits, which require nursing intervention.
People who experience longer term effects from cancer treatments will also need nursing intervention.
Section 5: Have the best care at the end of life
As lung cancer is associated with poor survival outcomes and significant morbidity, referral to palliative care can be appropriate at any stage of disease.3 Early referral of individuals with metastatic non-small cell lung cancer to palliative care has been associated with improved quality of life and mood, less aggressive care at end of life and extended survival.10
People with advanced lung cancer are likely to have supportive care needs across all domains of health that require nursing intervention. As well as ensuring optimal symptom management and psychosocial support, the SCN plays a key role in the coordination of care to ensure the person's wishes and needs are respected.