Introduction Lung cancer nurse specialists (LCNS) provide an extremely important service to patients. Their skill and expertise are valued very highly by both patients and colleagues, but it has proven difficult to measure their input objectively, leading to a lack of expansion (and in some areas contraction) of the workforce. Earlier this year the National Lung Cancer Audit (NLCA) reported that for 2009, patients who saw an LCNS were more than twice as likely to receive active anti-cancer treatment, but the relevance of this observation is obscured by a lack of case-mix adjustment and a high proportion of unrecorded data. We have sought to examine this finding more closely on the 2010 dataset (with less unrecorded data) by performing case-mix adjustment.
Methods Details of all patients from English trusts that were submitted to the NLCA database in 2010 were obtained. We then performed logistic regression analysis based on sex, age, stage and performance status to calculate mutually-adjusted ORs for overall and specific treatments. Since a patient would have reduced opportunity to access an LCNS if their survival were short, a second model was created excluding those patients who had survival of <28 days.
Results Of 30 334 in the dataset, 42 were removed due to missing sex (4), in situ disease (2) and occult stage (36). 74.8% were recorded as having been seen by a LCNS, 7.8% were not seen, and in 17.4% the outcome was not recorded. The latter two groups were combined for the remainder of the analysis. ORs for treatment if seen by a nurse in both models are shown below.
Conclusions Contact with a LCNS was associated with increased rates of active treatment, particularly chemotherapy or radiotherapy, but not surgery, and this effect was independent of sex, age, disease stage and performance status. While the LUCADA dataset does not contain detailed information on individual reasons for LCNS assessments, this should be investigated further as there may be important additions to the known benefits LCNS provide to patients. However, regardless of the explanation, all lung cancer patients should have the opportunity to benefit from the expertise of a LCNS.
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