New access route to lung cancer diagnosis (LUMEN)

In Wales approximately 1900 people a year die from lung cancer making it the biggest cause of cancer death in the country. More than 45% of cases are not diagnosed until stage 4 when treatment options are more limited. Earlier diagnosis and rapid access to potentially curative treatments such as surgery and radiotherapy are crucial to improve survival.

This project developed and tested a new access point for lung cancer diagnosis, allowing anyone who met the criteria to speak directly to a cancer nurse specialist to discuss their symptoms and, if appropriate, be booked in to have a chest X-Ray.

The phoneline service was operational between August 2022 and September 2023 and accepted self-referrals from patients registered with a GP in Carmarthenshire, Ceredigion or Pembrokeshire who were aged 40 or over with 1 or more of the following symptoms:

• Cough (more than 3 weeks)
• Losing weight without trying
• Shortness of breath
• Hoarse voice
• Repeated chest infections
• Chest pain
• More tired than usual
• Loss of appetite
• A lung condition with changing symptoms*

(*inclusion criteria in line with NICE criteria for urgent CXR for suspected lung cancer)

150 referrals were accepted by the LUMEN service while it was operational, with positive feedback from both patients and healthcare professionals. Evaluation of the service demonstrated that the cancer conversion rate was lower than expected at 0.67%, however some patients received diagnosis of other respiratory conditions. There is therefore good learning from this work to shape a potential Clinical Nurse Specialist-led Open Access Respiratory Hub. In addition, 27% of patients were referred to other specialists as a result of unresolved health needs identified following interaction with the LUMEN service, this included 21 referrals to the smoking cessation team.