Lung cancer (Oncology)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Emergency treatment required - needs discussion with on call specialist and/or emergency department.

    • Significant bleeding – including haemoptysis
    • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
    • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
    • Suspected spinal cord compression or cauda equina syndrome
    • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
    • Symptomatic malignant hypercalcaemia
    • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
    • Refer to local HealthPathways or local guidelines
    • Refer patients with suspected primary Melanoma through local surgical pathway for further investigation and management.
    • If the referring clinician organises a biopsy – please ensure a core or excisional biopsy is performed
    • Patients with some Stage 3 Melanoma may receive immunotherapy as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the General, Melanoma or Plastic surgical service, not medical oncology.
    • Histology (biopsy or surgical specimen) should include immunohistochemistry and next generation sequencing for BRAF mutation status.
    • For women and men who have not completed their family, fertility preservation needs to be discussed
    • For patients with incurable (metastatic or recurrent) cancer consider the following:
      • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the Women's and men's prognosis and their understanding of their prognosis
      • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
      • specific patient goals and values that may impact on treatment choices
      • whether the patient has been referred to a palliative or supportive care service
    • Quick reference guide
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

Patients with suspected lung cancer should be referred to the Respiratory team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

  • All small cell lung cancer that does not need emergency treatment (see emergency). For optimum care, patient should be seen within 2 weeks.
  • Biopsy proven advanced non-small cell lung cancer (preferably seen within 2 weeks)
  • Neoadjuvant treatment prior to curative surgery
  • Adjuvant treatment following curative surgery
  • Locally advanced disease for concurrent chemotherapy and radiation
  • Recurrence following previous treatment (Patients on surveillance after previous treatment for lung malignancy may be referred directly to medical oncology)
Category 2
(appointment within 90 calendar days)
  • Patients with previously treated stage 3 or stage 4 lung cancer requiring ongoing follow-up for five years post-diagnosis
  • Transfer of care from another health service
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Past medical history, current medications
  • Smoking history
  • Previous cancer treatment details
  • FBC ELFTs results
  • Any relevant XR results +/- relevant CT reports
  • CT chest, upper abdomen and pelvis
  • Tissue pathology +/- cytology results

3. Additional referral information Useful for processing the referral

  • Other available imaging
  • If available attach CT or MRI of the brain and bone scan
  • Biopsy result if available
  • Include (GP) Essential referral information
  • Physiological assessment - pulmonary function test if applicable
  • Bronchoscopy including endobronchial USS (EBUS) if applicable
  • PET scan reports for selected patients

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 14 May 2019

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