Respiratory[autotexts]

Lung cancer / Consultation template

Suspected lung cancer

First clinic assessment, written so the letter contains everything the MDT will ask for - starting with performance status.

Fills in order
  1. 1Referred with
  2. 2Date of first suspicion of cancer or ref…
  3. 3Cough, and any change in a long-standing…
  4. 4Haemoptysis
  5. 5Breathlessness, MRC
  6. 6Chest, shoulder or back pain
  7. 7Hoarseness
  8. 8Weight loss
  9. 9kg over
  10. 10Appetite and swallowing
  11. 11Bone pain
  12. 12Headache, seizures, focal neurology or p…
  13. 13Fatigue
  14. 14Smoking
  15. 15Occupational exposure, particularly asbe…
  16. 16Previous cancer, and treatment received

and 29 more, in the block below.

Paste block 45 fields 
Seen in the suspected lung cancer clinic.

Referred with: [imaging finding, symptom, or screening result]
Date of first suspicion of cancer or referral: []

History:
Cough, and any change in a long-standing cough: []
Haemoptysis: [amount, frequency, duration]
Breathlessness, MRC [1 to 5]
Chest, shoulder or back pain: []
Hoarseness: []
Weight loss: [] kg over [] months
Appetite and swallowing: []
Bone pain: []
Headache, seizures, focal neurology or personality change: []
Fatigue: []

Risk and background:
Smoking: [current or ex, pack-years, quit date]
Occupational exposure, particularly asbestos: [job, years, and what was done]
Previous cancer, and treatment received: []
Family history: []
Previous imaging available for comparison, and dates: []

Comorbidity relevant to treatment:
Cardiac disease: []
COPD or ILD, and lung function: []
Renal and liver function: []
Autoimmune disease, or immunosuppressive treatment: []
Anticoagulation: []
Cognition, and any concerns about capacity: []
Who is at home, and what support there is: []

ECOG performance status []
Weight [] kg   Height [] cm   BMI []
SpO2 []% on air

Examination:
Cervical and supraclavicular lymph nodes: []
Chest: []
Clubbing: []
Liver edge, skin nodules, bone tenderness: []
Neurological examination: []

Investigations to date:
Chest x-ray [date and finding]
CT chest and upper abdomen with contrast [date and finding]
Bloods including full blood count, renal, liver, bone profile and LDH: []

Impression:
[radiological stage and the differential], with an ECOG performance status of
[], suitable for [radical intent, systemic anticancer therapy, or best
supportive care] pending staging and tissue.

Plan:
1. [PET-CT, EBUS, CT-guided biopsy, bronchoscopy, pleural sampling, MRI head]
2. Lung cancer nurse specialist informed: []
3. Discussed at lung cancer MDT on []
4. Patient told: [what has been said today about the likely diagnosis]
5. Next contact: [who, when, and how]
6. Lung function and fitness assessment if radical treatment is possible: []

How to use it

Put the performance status in the letter every time. The regional MDT plans treatment from the referral, and without it the discussion stalls or the patient is deferred a week — surgeons and oncologists cannot select a treatment they have no fitness assessment for. Record what the patient has actually been told, in their words if possible: the commonest cause of distress in this pathway is a mismatch between what one clinician said and what the next assumed had been said. The asbestos question needs the job and the years, not a yes or no, because both compensation and the differential depend on the detail. Name the date of first suspicion — the pathway targets run from it.

Why it says that

None of this is in the copied text. It is here so you can check the block against its source, and change it when the source changes.

Trials behind it

  • CALGB 140503 2023 Sublobar resection matched lobectomy for small peripheral node-negative lung cancers
  • NELSON 2020 Volume CT screening reduced lung cancer mortality with a 2.1% referral rate
  • PACIFIC 2017 Consolidation durvalumab tripled progression-free survival after chemoradiotherapy in stage III lung cancer

Records on respiratorytrials.org.

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