Which patients are assessed by lung cancer nurse specialists? A national lung cancer audit study of over 128,000 patients across england

Background: Lung cancer nurse specialists (LCNS) are integral to the multidisciplinary clinical team, providing personalised physical and psycho-social interventions, and care management for people with lung cancer. The National Institute of Health and Care Excellence (NICE) recommend that all patients have access to a LCNS. We conducted a national study assessing whether there is variation in access to and timing of LCNS assessment. Methods: The National Cancer Action Team's LCNS workforce census in England was linked with patient and hospital Trust data from the English National Lung Cancer Audit. Multivariate logistic regression was used to assess features associated with LCNS assessment. Results: 128,124 lung cancer patients were seen from 2007 to 2011. LCNS assessment confirmation was 'yes' in 62%, 'no' in 6% and 'missing' in 32%. Where (in clinic versus ward) and when (before versus after diagnosis) patients were assessed by a LCNS also varied. Older patients with poor performance status, early cancer stage, and comorbidities were less likely to be assessed; there was no difference with sex or socioeconomic group. Patients receiving any anti-cancer treatment were more likely to be assessed. Assessment was lower in Trusts with high annual patient numbers (odds ratio = 0.58, 95% confidence interval 0.37-0.91) and where LCNS caseload > 250 (0.69, 0.41-1.16, although not statistically significant), but increased where workload was conducted mostly by band 8 nurses (2.22, 1.22-4.02). Conclusion: LCNS assessment varied by patient and Trust features, which may indicate unmet need for some patients. The current workforce needs to expand as well as retain experienced LCNSs.