Lung cancer is the leading cause of oncologic-related deaths worldwide.  Most individuals have advanced disease at diagnosis, which is paralleled with high morbidity.  Brain metastases (BM) represent one of the most serious complications, with recommendation of neuroimaging at diagnosis.  Palliative Care referral is inextricably linked with optimal patient care in this highly symptomatic patient group. 

 

A retrospective audit was undertaken for all newly diagnosed stage 3 and stage 4 NSCLC patients referred and seen at the Queen Elizabeth Hospital Oncology department over a two-year period.  Primary aims were two-fold, firstly to obtain qualitative data on whether current central nervous system (CNS) staging recommendations are being applied and secondly to evaluate methods and timing of palliative care integration. 

Thirty patients were eligible for inclusion.  Mean age at diagnosis was 68 years with adenocarcinoma being the most common histological subtype (66.7%).  Just over three quarters of patients (76.7%) were stage 4 at diagnosis.  We identified positive practice in neuroimaging rates at diagnosis with 73.3% of patients being imaged appropriately.  Just over one quarter (26.1%) of the stage 4 cohort had BM at diagnosis with median survival being shortest for this subgroup (91 days).  A total of 63.3% of patients were referred to palliative care with a median time from diagnosis to referral of 68 days.  Our data did not support the hypotheses that the detection of BM triggered palliative care referral.

 

Lung cancer is a prevalent disease which is often advanced at diagnosis.  Symptom burden is high with morbidity accentuated with the detection of BM.  This research demonstrates positive practice in the inclusion of neuroimaging at diagnosis in patients with advanced NSCLC.  Although we did not support a link between BM detection and palliative care referral, there was timely integration of palliative care in this highly symptomatic patient cohort.