This November is Lung Cancer Awareness month, which aims to promote awareness and early diagnosis of the disease. Lung cancer is the leading cause of cancer deaths worldwide (World Health Organization, 2023). But although this is a staggering and worrying statistic for patients and their loved ones, it perhaps does not reflect the advances made in the last decade.
When I first started lung cancer nursing in 2012, tyrosine kinase inhibitors (TKI) were relatively new treatments in this country. We would provide the patient with a pack designed to help manage the predictable side-effects of the tablet. This included creams and lotions for the irritating rash and Imodium for the expected diarrhoea.
“Lung cancer nursing is evolving to meet patients’ changing needs, with nurses acquiring new skills and knowledge to reflect the rapidly diversifying treatments now on offer”
Now, the list of targeted therapies is seemingly endless, as are the markers looked for on each patients’ biopsy. Samples are sent to regional genomics laboratories for next generation sequencing, giving oncologists a full molecular profile of the cancer; this can open up new avenues of treatment in either first- or second-line settings. Side-effects of these treatments are well managed and generally much less severe than previously seen.
Immunotherapy is being successfully used and, in some cases, patients with stage IV disease live for years after completing the initial two years of treatment. Immunotherapy works by targeting and blocking a receptor on the surface of T cells which are part of the immune system. In this way, it helps the immune system find and attack the cancer cells.
Both small cell lung cancer and mesothelioma are also being successfully treated with immunotherapy in combination with chemotherapy, giving better outcomes for these patient groups. But there is more to be done in treating these rarer forms of lung cancer for which it is still harder to achieve longer term survival.
While the treatment options are important to survival, we are also working hard to ensure patients are well prepared before they embark on a treatment plan by enrolling them onto a prehabilitation programme. This ensures they can live well with cancer throughout and following their treatment. Prehabilitation courses not only focus on exercise and smoking cessation, but also on nutrition and emotional wellbeing.
There are also advances in managing the symptoms of advanced lung cancer including indwelling pleural catheters for managing malignant pleural effusions. These empower patients to drain the fluid in their own homes as and when needed without attending hospital.
Since the Covid-19 pandemic, we have undoubtedly seen an increase in patients presenting with late-stage disease, either because they feared seeking help during the pandemic or didn’t recognise the signs or symptoms of concern. We must continue to educate people and raise the profile of lung cancer, so we can detect the disease earlier and improve patient outcomes.
Cancer nursing is constantly evolving and while the role of the traditional cancer nurse specialist (CNS) is still vitally important to patients and their loved ones, there is also an increase in advanced clinical practitioners supporting the medical team caring for patients living with cancer. These advanced roles align more closely to a junior doctor and should not replace the CNS, who is a constant source of patient support and guidance, coordinating care between trusts and specialist centres in an unparalleled way.
In the current economic climate, there is less appeal for nursing staff to leave the ward and become a cancer nurse specialist as the office hours nature of most of CNS roles means less possibility of sociable hours payments. This together with the lack of a clear career progression for CNS roles leads to many nurses to favour the apprentice advanced clinical practice scheme, which offers strong career development.
Cancer nursing offers a unique opportunity to support patients’ prehabilitation, treatment, rehabilitation, recovery and living with and beyond cancer (Royal College of Nursing, 2022). There is much scope within the role to develop specialist skills and hugely improve the patient’s journey. It is essential we continue to educate student nurses and the nursing workforce on the importance of the cancer nurse role. The role is so often undervalued in the NHS and cancer nurse teams are often overlooked when there is additional resource available.
Targeted lung health checks will be available across the country by 2029. These will increase the number of patients diagnosed with early-stage disease, so reducing the number of late-stage presentations and improving lung cancer survival.
So, while lung cancer is the leading cause of cancer deaths worldwide, it is also the focus of research and development on a scale never seen before. Lung cancer nursing is evolving to meet patients’ changing needs, with nurses acquiring new skills and knowledge to reflect the rapidly diversifying treatments now on offer.
Rachel Halliday is lung cancer and pleural specialist nurse at the Countess of Chester Hospital and pleural lead for the Association of Respiratory Nurses
References
Royal College of Nursing (2022) Career Pathway and Education Framework for Cancer Nursing. RCN.
World Health Organization (2023) Lung Cancer, who.int, 26 June (accessed 20 November 2023).