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Lung cancer (Oncology)

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Emergency treatment required - needs discussion with on call specialist and/or emergency department.

 

  • Symptoms of airway obstruction, SVC obstruction
  • Severe gastrointestinal (GI) bleeding
  • Bowel obstruction
  • Febrile neutropenia
  • Symptomatic hypercalcaemia
  • Other organ failure/dysfunction
  • Uncontrolled and disabling pain
  • Massive haemoptysis and/or stridor
  • Neurological signs suggestive of brain metastases or cord compression
  • Very high calcium (3.0mmol/L)
  • Severe dysphagia with dehydration
  • Biopsy proven small cell lung cancer
    • patients with symptoms of shortness of breath, deteriorating organ function
  • Metastatic germ cell tumour (GCT) confirmed (biopsy) or suspected (tumour markers)
  • Patients with severe symptoms, organ failure or life threatening complications
  • Highly aggressive lymphoma
    • Burkitt’s lymphoma
    • lymphoblastic lymphoma
  • Acute leukaemia
  • Suspected lung cancers (mass on chest XR or CT chest) needs to be referred to the appropriate specialist (usually respiratory physician) for work-up.  Specialist review optimally should be within 2 weeks
  • Most referrals for locally advanced disease for concurrent chemotherapy and radiation come through respiratory or cardio-thoracic team and after MDT review
  • Suspected spinal cord compression, superior vena cava syndrome (SVC), massive haemoptysis, very high calcium (>3.0mmol/L), febrile neutropenia need to be referred to emergency urgently
  • Lung cancer patients diagnosed and treated via an MDT have improved outcomes
  • For patients with incurable (metastatic or recurrent) cancer, consideration of the following:
    • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the patient’s prognosis and their understanding of their prognosis
    • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
    • specific patient goals and values that may impact on treatment choices
    • whether the patient has been referred to a palliative or supportive care service
  • Investigating symptoms of lung cancer. A guide for GP’s

  • Optimal care pathway for people with lung cancer

  • Quick reference guide

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • All small cell lung cancer that does not need emergency treatment (see emergency).  For optimum care, patient should be seen within 2 weeks.

     

    Biopsy proven non-small cell lung cancer

    • Locally advanced disease for concurrent chemotherapy and radiation
    • Metastatic disease
    • Adjuvant treatment following curative surgery
    • Recurrence following previous treatment

    (Patients on surveillance after previous treatment for lung malignancy may be referred directly to medical oncology)

  • Category 2
    (appointment within 90 calendar days)
    • Patients with previously treated lung cancer
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

GP Essential Referral Information

  • General referral information
  • Past medical history, current medications
  • Smoking history
  • Previous cancer treatment details
  • FBC ELFTs results
  • Any relevant XR results +/- relevant CT reports
    • CT chest, upper abdomen and pelvis
    • If available attach CT or MRI of the brain and bone scan

Specialist Essential Referral Information

  • Include (GP) Essential referral information
  • Tissue pathology +/- cytology results
  • Physiological assessment - pulmonary function test if applicable
  • Bronchoscopy including endobronchial USS (EBUS) if applicable
  • PET scan reports for selected patients

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.