Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy?

Stewart, Iain; Khakwani, Aamir; Hubbard, Richard B.; Beckett, Paul; Borthwick, Diana; Tod, Angela; Leary, Alison; Tata, Laila J.

Abstract

Objectives

Treatment choices for people with lung cancer may be influenced by contact and engagement with lung cancer nurse specialists (LCNSs). We investigated how service factors, LCNS workload, and LCNS working practices may influence the receipt of anticancer treatment.
Materials and methods

English National Lung Cancer Audit data and inpatient Hospital Episode Statistics for 109,079 people with lung cancer surviving 30 days from diagnosis were linked along with LCNS workforce census data and a bespoke nationwide LCNS survey. Multinomial logistic regression was used to determine adjusted relative risk ratios (RRRs) for receipt of anticancer therapies associated with LCNS assessment, LCNS workforce composition, caseload, LCNS reported working practices, treatment facilities at the patients’ attending hospitals, and the size of the lung cancer service.

Results

Assessment by an LCNS was the strongest independent predictor for receipt of anticancer therapy, with early LCNS assessments being particularly associated with greater receipt of surgery (RRR 1.85, 95%CI 1.63–2.11). For people we considered clinically suitable for surgery, receipt was 55%. Large LCNS caseloads were associated with decreased receipt of surgery among suitable patients (RRR 0.71, 95%CI 0.51–0.97) for caseloads >250 compared to ≤150. Reported LCNS working practices were associated with receipt of surgery, particularly provision of psychological support (RRR 1.60, 95%CI 1.02–2.51) and social support (RRR 1.56, 95%CI 1.07–2.28).

Conclusion

LCNS assessment, workload, and working practices are associated with the likelihood of patients receiving anticancer therapy. Enabling and supporting LCNSs to undertake key case management interventions offers an opportunity to improve treatment uptake and reduce the apparent gap in receipt of surgery for those suitable.

Citation

Stewart, I., Khakwani, A., Hubbard, R. B., Beckett, P., Borthwick, D., Tod, A., …Tata, L. J. (2018). Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy?. Lung Cancer, 123, 160-165. https://doi.org/10.1016/j.lungcan.2018.07.022

• Journal Article Type: Article
• Acceptance Date: Jul 16, 2018
• Online Publication Date: Jul 17, 2018
• Publication Date: Sep 30, 2018
• Deposit Date: Aug 9, 2018
• Publicly Available Date: Aug 10, 2018
• Journal: Lung Cancer
• Print ISSN: 0169-5002
• Electronic ISSN: 1872-8332
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 123
• Pages: 160-165
• DOI: https://doi.org/10.1016/j.lungcan.2018.07.022
• Keywords: Lung cancer; Nurse specialists; Treatment; Workload; Case management; Clinical audit
• Public URL: https://nottingham-repository.worktribe.com/output/987273
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0169500218304823?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Are working practices of lung cancer nurse specialists associated with variation in peoples’ receipt of anticancer therapy?; Journal Title: Lung Cancer; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.lungcan.2018.07.022; Content Type: article; Copyright: © 2018 The Authors. Published by Elsevier B.V.
• Contract Date: Aug 9, 2018