Developing a Lung CNS Service at a Tertiary

Developing a Lung CNS Service at a Tertiary

Developing a Lung CNS Service at a
Tertiary Specialist Oncology Centre
Authors: Neal, Hilary1; Eaton, Marie2; Fenemore, Jackie3; McEntee, Delyth4; Wray, Delwyn5 Cooper, Victoria6; Mellor, Fran7


The UK sees more than 39,000 diagnoses of lung
cancer a year. It is the leading cause of cancer
deaths in women and it affects smokers and
never smokers (NICE 2011). There is increasing
evidence in support of the role of the clinical nurse
specialist (CNS) and the value that they are able
to add to the patient experience and pathway
(RCN 2010).

The project is at the end of its first year. So far we have seen an increase in patient access to,
and contact from a CNS by 200% (fig 1). Calls to the Support line have doubled (fig 2), with
the greatest number of contacts being made by Health Care Professionals (fig 3).

In addition, there is a growth of support for the
role of the CNS within leadership and quality
improvement (Fickleman 2013).
Figure 1

The Christie Hospital NHS Foundation Trust has
seen a steady rise in the number of lung cancer
patients referred to them resulting in an increase
in Lung Oncologists by 66%. The Lung Cancer
consultants expressed a keenness to establish
more CNS involvement in their patients care. This
created a case to develop the size of the team
and initiate an improvement project to enhance
the way in which patients receive care for lung
cancer through a more integrated and proactive
CNS team.

Figure 2

A partnership was set up between Macmillan and
the Christies Lung Cancer CNS Team. The primary
aim was to review and improve the current patient
pathways across the network and the critical points
at which CNS input is required. This objective
included an analysis of the gaps in the current
A two year project plan was developed with the
addition of a Project Manager funded by
Macmillan. Objectives included:
To develop a more defined handover/transition
point in the patient pathway for the transfer of CNS
support from local hospital to the Christie to ensure
a more consistent, appropriate and seamless
pathway the lung cancer patient population.
To align the CNS team with Greater Manchester
sectors and establish communication with local
teams within each sector.
To analyse the current lung cancer nurse team
workload e.g. telephone work to optimise
efficiencies was undertaken to ensure specialist
skills are utilised and assess where they can
deliver the most benefit to patients.
To explore innovative ways of communicating with
patients throughout their treatment pathway,
through the use of digital and telephony media.

Figure 3
The CNS team has doubled in size from 2 FTE to 4 FTE which has enabled the team to align
to the four Greater Manchester Sectors. Communication between the local CNS teams and
the Christie has been established which has enhanced the transition of information and care
for patients.

Year/Phase 2 Project Objectives
Develop a project with patients with extensive stage small cell lung cancer using Patient
Related Outcomes (PROs) to prevent adverse events.
Develop a Risk Assessment Matrix Tool to identify the specific needs of patients along their
treatment pathway.
Recruit a Service User Co-Ordinator to engage with users and the community/third sector
care to ensure user involvement and improved information/support for patients.
Formalise the use of the Macmillan eHNA to assess the patients needs at various points
along the National Optimal Lung Cancer Pathway.
Establish and develop Nurse Led assessment clinic for patients receiving oral therapies and
concurrent chemo/radiotherapy treatments.

NW Sector
-Royal Bolton
-Wigan & Wrightington
-Salford Royal

NE Sector
-Royal Oldham
-North Manchester
-Fairfield (Bury)

Central Sector
-Manchester Royal Infirmary
-Stepping Hill

South Sector
1 ,2, 3,4,5

The Christie NHS Foundation Trust, 6,7 Macmillan Cancer Support

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