Bankstown Hospital - Grand Rounds - Further Reading

Welcome to the Grand Rounds Further Reading List, Respiratory edition, brought to you by the Clinical Library, on Level 4, next to the Auditorium.

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Lung Cancer Screening in Australia.

A new era of early detection and incidental dilemmas

Marjanovic, S., et al. (2024). "Systems mapping: a novel approach to national lung cancer screening implementation in Australia." Transl Lung Cancer Res 13(10): 2466-2478   2226-4477

Transl Lung Cancer Res. 2024 Oct 31;13(10):2466-2478. Epub 2024 Oct 28.  https://pmc.ncbi.nlm.nih.gov/articles/PMC11535840/   FULL TEXT AT LINK

BACKGROUND: Lung cancer screening with low-dose computed tomography has been started in some high-income countries and is being considered in others. In many settings uptake remains low. Optimal strategies to increase uptake, including for high-risk subgroups, have not been elucidated. This study used a system dynamics approach based on expert consensus to identify (I) the likely determinants of screening uptake and (II) interactions between these determinants that may affect screening uptake. METHODS: Consensus data on key factors influencing screening uptake were developed from existing literature and through two stakeholder workshops involving clinical and consumer experts. These factors were used to develop a causal loop diagram (CLD) of lung cancer screening uptake. RESULTS: The CLD comprised three main perspectives of importance for a lung cancer screening program: participant, primary care, and health system. Eight key drivers in the system were identified within these perspectives that will likely influence screening uptake: (I) patient stigma; (II) patient fear of having lung cancer; (III) patient health literacy; (IV) patient waiting time for a scan appointment; (V) general practitioner (GP) capacity; (VI) GP clarity on next steps after an abnormal computed tomography (CT); (VII) specialist capacity to accept referrals and undertake evaluation; and (VIII) healthcare capacity for scanning and reporting. Five key system leverage points to optimise screening uptake were also identified: (I) patient stigma influencing willingness to receive a scan; (II) GP capacity for referral to scans; (III) GP capacity to increase patients' health literacy; (IV) specialist capacity to connect patients with timely treatment; and (V) healthcare capacity to reduce scanning waiting times. CONCLUSIONS: This novel approach to investigation of lung cancer screening implementation, based on Australian expert stakeholder consensus, provides a system-wide view of critical factors that may either limit or promote screening uptake.

Marshall, H. M., et al. (2019). "Cost of screening for lung cancer in Australia." Internal Medicine Journal 49(11): 1392-1399  https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.14439 PDF AT LINK

Abstract: Background Lung cancer screening can reduce lung cancer mortality. Australian cost estimates are important to inform policy but remain uncertain. Aim To describe the first direct medical costs associated with lung cancer screening in Australia. Methods Single-centre prospective screening cohort. Healthy volunteers (age 60–74 years, current or former smokers quit <15 years prior to enrolment, ≥30 pack-years exposure) underwent baseline and two annual incidence computed tomography (CT) screening scans. Health status and healthcare usage data were collated for 5 years. The main outcome measures were: rates of lung cancer; individual healthcare resource use derived from multiple data sources adjusted to 2018 Australian Medicare Benefits Schedule values. Results A total of 256, 239, 233 participants was screened at each round respectively; 12 participants were diagnosed with lung cancer during screening and 2 during follow-up: 9 underwent surgery, 4 received concurrent chemoradiation, 1 received palliative chemotherapy. One surgical case died from lymphoma 1407 days after diagnosis, all other surgical cases survived >5 years. Non-surgical median survival post-diagnosis was 654 days. Gross trial cost was Australian dollar (AU$) 965 665 (AU$397 396 CT scans; AU$29 303 false-positive scan work-up; AU$96 340 true-positive scan workup; AU$336 914 lung cancer treatment; AU$104 712 lung cancer follow-up post-treatment). Average total direct medical cost per participant was AU$3 768. Average direct cost of surgery was AU$22 659; average non-surgical cost was AU$47 395 (radiotherapy, chemotherapy, palliative care). Conclusions Advanced cancer cost more to treat and had worse survival than early cancer. Screening costs are similar to international studies and suggest that lung cancer early detection could limit treatment costs and improve outcomes.

Rose, S., et al. (2025). "Australia's National Lung Cancer Screening Program—It's Time to Address the Stigma in the Room." Health Promotion Journal of Australia 36(2): e70011  https://onlinelibrary.wiley.com/doi/abs/10.1002/hpja.70011 PDF AT LINK

  ABSTRACT: The National Lung Cancer Screening Program is commencing in Australia in July 2025. This significant public health initiative will maximise earlier detection of lung cancer and improve outcomes for many Australians. However, the adoption of a screening program for a disease that is stigmatised, given the known links between tobacco smoking and lung cancer, creates barriers for participation. In this perspective, we argue the need to challenge public rhetoric around smoking being a ‘choice’ and the importance of dialogue that is free of judgement and blame towards individuals. We briefly examine initiatives that have been implemented to reduce public stigma and highlight the multi-level considerations to ensure that everyone, regardless of having smoked or not, receives the quality care and support that they deserve.

Smythe, K., et al. (2025). "Developing an Integrated Service Planning Tool: Lessons Learnt from

Int J Integr Care. 2025 Apr 22;25(2):2. doi: 10.5334/ijic.8976. eCollection  2025 Apr-Jun. 

https://pmc.ncbi.nlm.nih.gov/articles/PMC12023144/ PDF AT LINK

AIM: We aim to provide practical guidelines on how to develop integrated service plans that incorporate care provided by multiple specialties. INTRODUCTION: Bringing specialties together to strategically plan future health service delivery is challenging. In Australia, collaboration between specialties is required to prepare for the introduction of the National Lung Cancer Screening Program (NLCSP). The purpose of this investigation is to provide practical guidelines on how to develop integrated service plans that incorporate care provided by multiple specialties. DESCRIPTION: Collaborative planning was undertaken in Western Sydney Local Health District (WSLHD) to develop a WSLHD Thoracic Oncology Program Service Plan. The planning process included oversite by a steering committee, engagement of a range of stakeholders, a series of interviews, meetings and workshops, and the documentation of the strategies and actions required to implement the plan. The planning process was analysed to produce an Integrated Service Planning Tool (ISPT). DISCUSSION: The ISPT includes five key enablers for the planning process: foster a strong culture of collaboration; establish strategic governance; identify a patient journey framework; conduct extensive and flexible stakeholder consultation; and formalise the plan with documentation of a roadmap. Key actions for each enabler translate the ideas into activities. CONCLUSION: A culture of collaboration across specialties supports the development of an integrated service plan that encompasses the full patient journey. The ISPT provides a blueprint for overcoming a traditional siloed approach to service planning for diseases and conditions that require interdisciplinary care.

Williams, L., et al. (2025). "Identifying Research Priorities for Occupational Lung Cancer in Australia." American Journal of Respiratory and Critical Care Medicine 211(Abstracts): A6354-A6354  https://www.atsjournals.org/doi/abs/10.1164/ajrccm.2025.211.Abstracts.A6354 PDF AT LINK

  RATIONALE: Occupational lung cancer is a preventable disease caused by the inhalation of lung carcinogens in the workplace. Despite increased prevalence, the newly commencing national lung cancer screening program in Australia does not include occupation as criterion for screening. As a national healthcare priority there is a need for a more strategic approach to research to address the prevention, detection, and management of this condition. Thus, our aim was to collaboratively identify the top research priorities for occupational lung cancer. METHODS: The priority setting was conducted over stages and based on a modified James Lind Alliance framework. Stakeholders included people impacted by/at-risk of occupational lung cancers, family members/caregivers, multidisciplinary workplace safety and healthcare professionals, regulators, worker representatives, legal professionals, and researchers. Stage one involved an open-ended questionnaire which asked respondents to provide the most important issues/topics they felt research should address regarding five priority areas: exposure, prevention, screening, diagnosis, and management. Thematic analysis was used to identify key topics within each area. Stage two involved a face-to-face workshop to rank the topics and collaboratively develop targeted research questions to inform future research. RESULTS: 78 participants completed the questionnaire and 54 attended the face-to-face workshop. Research priorities included exposure: epidemiological studies, high-risk occupations and exposures, cumulative and combined risk factors; prevention: education, barriers and facilitators to effective prevention and control, compliance; screening: understanding who should be screened, screen criteria, screening implementation; diagnosis: attribution, education for health professionals, diagnostic techniques; and management: psychosocial impacts and support, care coordination, and compensation. CONCLUSIONS: Findings provide insights into important research areas that are of greatest importance to key stakeholders which will be fundamental to guiding the future direction of occupational lung cancer research.

Therapeutic Guidelines -  Respiratory.

Available via CIAP (login required for home use).

BMJ Best Practice. Available via CIAP (login required for home use).