Download 5. Paul Fenton Emergency Presentation Lung Cancer

Emergency Presentations
in Lung Cancer
2nd March 2016
Paul Fenton
Consultant Clinical Oncologist
Lung Cancer in the UK
1 year survival
1 year survival (%)
CSCCN
DCN
Routes to Diagnosis 20062013
All cancers
Lung cancer
Lung cancer: one year survival
estimates by route to diagnosis
Lung cancer: risk factors for
emergency presentation
All Lung Cancer:
37%
Male
GENDER
Female
Under 50
50-59
60-69
AGE
70-79
80-84
85+
0%
10%
20%
30%
40%
50%
% of Lung Cancers presen ng as Emergency
60%
Lung cancer: risk factors for
emergency presentation
All Lung Cancer:
37%
1
SOCIOECONOMIC
GROUP
2
3
4
5
Asian
Black
ETHNIC ORIGIN
Chinese
Mixed
White
Other
Unknown
0%
5%
10% 15% 20% 25% 30% 35% 40% 45%
% of Lung Cancers presen ng as Emergency
Emergency Presentation - Symptoms
• Multiple symptoms
• Acute respiratory symptoms
– Shortness of breath
– Infection
– Chest pain
• Non- respiratory symptoms
–
–
–
–
Anorexia/ weight loss
Pain
Confusion
Neurological dysfunction
• 222 EP cases reviewed
• 32% lung Ca
– 55% advanced/metastatic
• Lung Ca patients:
– 41/60 symptoms
• Colorectal Ca patients:
– 14/60 symptoms
Emergency Presentation - Pain
• 68 year-old male
smoker
• 8 week history of low
back pain radiating to
L leg
• Tried acupuncture,
chiropractor
• Weight loss, sweats
• Attended ED
8 weeks lower back pain
NSCLC
Emergency Presentation - SOB
• 60 year-old female
ex-smoker
• 6 week history of
cough and shortness
of breath
• 2 courses of ABx
• Called 111 with acute
SOB
Emergency Presentation - SOB
Emergency Presentation – Fall
• 58 year-old female exsmoker
• 3 month history of anorexia,
weight loss and fatigue
• Long history of
anxiety/depression, limited
contact with GP
• Attended ED following fall
• Discharged but readmitted
Emergency Presentation – Fall
Emergency Presentation – pain/ neurology
• 72 year-old male smoker,
ex–dock worker
• 8 week history of pain and
reduced function R
arm/shoulder following fall
• No contact with GP
• Attended ED “couldn’t bear
it any more”
Emergency Presentation – pain/ neurology
Moving forward
Recommendations
•
•
•
•
•
•
Signs and Symptoms
Screening
Identifying high risk patients
Early Diagnosis
Emergency Presentation pathways
Referral
–
–
–
–
Direct CT referral
CXR/ CT reporting within 4 days
Direct telephone/ e-mail access
Centralised data sharing
• Specialist Nurses
Improving treatment in Lung Cancer
• Early Stage
– Improved surgical techniques
– Stereotactic radiotherapy
• Curative treatment despite comorbidities
Improving treatment in Lung Cancer
• Locally Advanced
– Improvements in ChemoRT
• Improving survival, less toxicity
Improving treatment in Lung Cancer
• Metastatic disease
– Aggressive options in oligometastatic disease
– Advances in chemotherapy, biological therapies
and immunotherapy
• Improving survival, greater individualisation
… but not yet cure
Thanks to
• Lung Cancer, Radiotherapy and Acute
Oncology teams at UHS