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Issues at the interface between primary and secondary care in the management of common respiratory disease • 1
The challenge of improving the delivery of lung cancer care
    1. Martin F Muersa,
    2. William F Holmesb,
    3. Clare Littlewoodc
    1. aThe General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK, bSherrington Park Medical Practice, Mansfield Road, Nottingham NG5 2EJ, UK, cMacMillan Consultant in Palliative Medicine, Palliative Care Team, St Helens and Knowsley Hospital, Prescot, Merseyside L35 1LR, UK
    1. Dr M F Muers.

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    Lung cancer has a poor prognosis. It is reasonably common in general practice, needs good palliative care, and requires co-operation between several health care teams to be managed well. This article deals with meeting this challenge within the British NHS, but the issues discussed have implications for other health care systems.

    The National Cancer Guidance Group (NCGG) recommends that all patients with lung cancer should be treated by a multidisciplinary team led by a respiratory physician, that both the primary health care team and the palliative care team should be fully involved, and that all decisions regarding the patient’s management should be rapidly and effectively communicated between these three teams.1 The report of the Standing Medical Advisory Committee (SMAC) published in 1994,2 among others, clearly recognises the place of primary care in the management of lung cancer and emphasises the need for co-operation between disciplines: “The nature and frequency of the disease means that the work of general practitioners and their colleagues must be integrated with that of secondary, tertiary and palliative care if high quality services are to be provided”.

    Achieving this level of communication and co-operation is crucial if those treating patients with lung cancer are to deliver high quality care.

    How common is lung cancer in general practice?

    According to the SMAC report,2 “in the United Kingdom a group practice of five general practitioners with 10 000 patients will have around five patients dying each year from lung cancer. At least one patient will require palliative care services at any one time”. Averages, however, are misleading. There are very large variations in the incidence of lung cancer both between different regions of countries and between different districts within a region.3 Furthermore, there are demographic changes within the population who experience lung cancer which will modify the way that it will present to …

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