High levels of comorbidities among patients makes it challenging to manage patients with lung cancer — — — — — — — — — — High levels of comorbidities make me less likely to pursue aggressive treatment — — — — — — — — — — Please provide any comments relating to investigation, diagnosis and management of lung cancer 6. Treatment and management of lung cancer This section seeks your views on factors influencing lung cancer treatment and management in Australia 1. We are interested in identifying your level of agreement with a series of statements. Each statement will be marked 1 to 10. One (1) denotes that you strongly disagree with the statement while 10 shows that you strongly agree with the statement. Statement 1 2 3 4 5 6 7 8 9 10 agree I have ready access to radiotherapy services — — — — — — — — — — I have ready access to expert thoracic surgical services — — — — — — — — — — I have ready access to chemotherapy services — — — — — — — — — — I have ready access to allied health services, such as dietitians and occupational therapists — — — — — — — — — — I have ready access to a multidisciplinary team to assist with managing my patients — — — — — — — — — —
Lung cancer nurses. Timeliness to get treatment. Mobile multidisciplinary care teams to help in rural and remote areas. National commitment to reduce smoking in all age groups. Proper MDTs. Universal access to specialist lung cancer nurses. Increased timeliness of referral to bulk billing services. Better outreach services to rural areas. Improved access to diagnostic bronchoscopy—akin to open access endoscopy. Palliative Care Involvements. More EBUS for Dx and staging. Case manager/liaison nurse. More pt-centred clinical research. Multidisciplinary teams. More resources for allied health professionals. Faster availability of treatments when supporting evidence becomes available. More support with smoking cessation. Improved support services. Medicare item number for multidisciplinary team meeting in private practice—all done at present in our own time without financial reward. Tax cigarettes at $30 packet. Remove stigma applied to smokers. Awareness/outreach to resp physicians. Funding for better availability of radiology and pathology tests. Earlier diagnosis; good screening test. More gp education via local hospitals. Palliative care services. Multidisciplinary help throughout Australia.
Question 10.2: In your opinion, do you think guidance material to monitor patients with a high risk for lung cancer would be beneficial? Table 10.2: Statistical results Statistical results Frequency Percent No 23 15.34 Yes 92 61.33 Not answered 35 23.33 Total 150 100 Figure 10.2 Benefits of developing guidance materials for monitoring high risk patients Question 11.1: From your experience please indicate your level of agreement of the influence of the following factors on the effective TREATMENT of lung cancer Table 11.1: Statistical results Statistical results Treatment Treatment professional Access to guidance materials / Specialist care Failure to follow up patients at risk Surgical intervention delays Medical oncology intervention delays Radiotherapy intervention delays Long distance to specialist services Access to team Patient reluctance to travel Variations in palliative care Variations in surgical treatment Variations in oncological treatment Variations in radiotherapy N - Valid 106 106 106 106 106 105 106 107 106 107 107 106 106 104 N - Missing 27 27 27 27 27 28 27 26 27 26 26 27 27 29 Mean 5.86 6.11 5.46 6.03 5.29 4.85 5.59 6.74 5.61 5.22 5.31 5.20 5.16 5.12 Median 6.00 6.00 5.00 6.00 5.00 5.00 6.00 7.00 5.50 5.00 5.00 5.00 5.00 5.00 Std. Deviation 2.223 2.273 2.318 1.954 2.125 2.152 2.441 2.169 2.569 2.312 2.349 2.188 2.057 2.101 Percentiles - 25 4.00 5.00 4.00 5.00 3.00 3.00 3.75 5.00 3.00 3.00 3.00 3.00 3.00 3.00 Percentiles - 50 6.00 6.00 5.00 6.00 5.00 5.00 6.00 7.00 5.50 5.00 5.00 5.00 5.00 5.00 Percentiles - 75 8.00 8.00 7.00 8.00 7.00 6.00 8.00 9.00 8.00 7.00 7.00 7.00 6.00 7.00 Figure 11.1: Factors influencing the effective treatment of lung cancer 11.1 Open-ended Comment:
Appendix 7: Thematic Analysis from Expert Participants System Themes Illustrative quotes Ability to provide and coordinate lung cancer services Need for coordination and communication and monitoring of outcomes Need to coordinate public and private health care settings Distance from specialist centres impacts on access Increasing specialisation increases the emphasis on specialist centres Multidisciplinary teams seen as integral Navigating the system is challenging for patients and general practitioners "multiple providers, multiple investigations can lead to delays in diagnosis" (Medical oncologist) "a team approach is what is necessary" (Surgeon) "inordinate, unnecessary delays occur" (Medical Oncologist) "being able to go to a private hospital fast tracked [spouse] treatment (Consumer) "people can just get lost in the system" (Dietician) "There is a need for a carrot and stick approach [to monitor and improve outcomes" (Respiratory Physician) "In order to obtain Medicare reimbursement there should be demonstration that a physician has accessed a multidisciplinary team" (Medical Oncologist) "it is a bit hit and miss how quickly you get into the system" (Care Coordinator) "Network systems work well to coordinate care" (Policy) "Need for systematic follow-up of abnormal (Radiologist) "Up to 48% of the surgery happens in the private sector" (Policy) Provider Themes Illustrative quotes Capacity to provide lung cancer services General practitioners have minimal exposure to lung cancer Workforce shortages Increasing need for specialisation Perception of greater accessibility through the private sector Views of lung cancer management are not always up to date "amongst some clinicians there is a perception of nihilism regarding treatment decisions" (Medical Oncologist) "No shortage of surgeons—people have to be prepared to travel" (Thoracic Surgeon) "Physicians not switched on to lung cancer" (Medical Oncologist) "Comorbidities and age can result in failure to consider surgery" (Thoracic Surgeon) "I just don't see lung cancer in my practice and so I guess I am less switched onto it" (General Practitioner) "lots of information from non-experts" (Palliative care physician) "Options are not always portrayed accurately to the patient" (Respiratory physician)