Frailty is a complex syndrome which can be accelerated by lung cancer, its symptoms and treatments. Lung cancer presents unique challenges within this population, which can significantly impact upon function and quality of life. We aimed to ascertain whether a specialist occupational therapist could provide timely assessment and intervention to manage frailty, symptoms such as fatigue and breathlessness, reduce social admissions to hospital, maintain function and increase the frequency of future planning conversations.
The Newcastle upon Tyne Hospitals NHS Foundation Trust funded a one-year pilot with charity funds to recruit x1 full-time specialist occupational therapist to design and run the Lung Cancer Outpatient Occupational Therapy Service from April 2021. Data collected included patient demographics, socioeconomic deprivation, clinical frailty scores, admission avoidance, bed days in hospital, clinical interventions and future planning conversations.
98 patients (43 male, 55 female) with a mean age of 72 received an occupational therapy assessment over a 40 week period. 571 contacts took place and 569 interventions were delivered (mean: 5.8 per patient). Patients scored 5.3 on average using the Clinical Frailty Scale at initial assessment (range 4-7), presenting a mild/moderate level of frailty. 35% (n=34) engaged in future planning conversations and as a result 75% of patients achieved their preferred place of death. To date 43 patients are deceased (median 52 days between assessment and date of death). 26 visits to the emergency department/admissions to hospital were avoided as a result of rapid intervention and there were no admissions for social reasons. Bed days in hospital were reduced by 4.85 days (12.25 VS 7.40). Feedback from patients and the multidisciplinary team was positive.
Patients with lung cancer have high levels of physical, psychological and social need due to their disease and its symptoms. Occupational therapists specialising in oncology possess an array of clinical skills that can tackle frailty, symptom management, functional disruption and future planning early in the clinical pathway.
Legal entity responsible for the study
Charlie Bear for Cancer Care funds this post (The Newcastle upon Tyne Hospitals NHS Foundation Trust's Cancer Charity).
The author has declared no conflicts of interest.