title: Postoperative oncological referral patterns for adjuvant treatment of patients undergoing curative resections for non-small-cell lung cancer at a regional thoracic centre.
abstract: OBJECTIVE
  The Heartlands hospital provides services for 13 hospitals in the Pan Birmingham, Three Counties and Arden Lung Cancer Networks. After surgery for lung cancer, patients may be referred for adjuvant chemotherapy. The referral patterns and follow-up of patients differ between the various trusts. This study examines the current referral patterns following surgery with a view to identify areas for improvement.
  
  
  METHODS
  We performed a retrospective review of 115 patients who underwent curative anatomical resection between April 2006 and March 2007. We reviewed the patient's progress following discharge from the surgeons at various defined points, including discussion at a multidisciplinary team (MDT) meeting following surgery, referral to oncologist, oncology treatment acceptance and adjuvant treatment completion.
  
  
  RESULTS
  Of the 115 patients, four patients died after surgery. The demographics of the surviving 111 patients mirrored the national trends with the average age being 69+9.6 years. The predominant tumours were adenocarcinomas (44.1%) and squamous cell cancers (44.1%). A total of 82 patients were discussed in an MDT meeting and a further 16 patients were directly referred to the oncologists for consideration for chemotherapy. As many as 67 patients were referred for chemotherapy. Forty-eight patients were offered chemotherapy, 38 patients accepted and 25 of them completed the chemotherapy. Thirteen patients could not complete due to drug toxicity. Data collection for the study highlighted organisational problems with data collection and non-uniformity in the role of the lung cancer co-ordinators. The postoperative management of stage I lung cancer patients varied between the units.
  
  
  CONCLUSIONS
  This study highlights areas of improvement in the current patient pathway for postoperative patients following lung cancer surgery and stresses the importance of achieving a consensus with regard to the management of resectable lung cancer. A method of data collection that is accurate, easily accessible and complete is recommended to help in future auditing of patient outcomes and help in improvement of services.
authors: Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, United Kingdom.
authors: Remananda Krishnanand
authors: RK
authors: Pai
authors: Sridhar
authors: S
authors: Rathinam
authors: Vishnu
authors: V
authors: Sharma
authors: Ehab
authors: E
authors: Bishay
authors: Richard S
authors: RS
authors: Steyn
authors: Pala Babu
authors: PB
authors: Rajesh
authors: Maninder
authors: M
authors: Kalkat
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D019091:Critical Pathways; D004739:England; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents