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Pulmonary nodules

Useful management information

  • Suspected lung cancer (Mass on chest XR or CT chest) needs to be referred to the Respiratory Department for work-up. Haemoptysis with suspected lung cancer needs to be referred to the respiratory physicians
  • Most referrals for locally advanced disease for concurrent chemotherapy and radiation come through respiratory or cardio-thoracic team and after MDT review
  • Suspected spinal cord compression, superior vena cava syndrome (SVC), massive haemoptysis, very high calcium (>3.0mmol/L), febrile neutropenia need to be referred to emergency urgently
  • Lung cancer patients diagnosed and treated via an MDT have improved outcomes
  • For patients with incurable (metastatic or recurrent) cancer, consideration of 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 patient’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
  • Investigating symptoms of lung cancer. A guide for GPs
  • Optimal care pathway for people with lung cancer
  • Quick reference guide

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • 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 non-small cell lung cancer

  • Locally advanced disease for concurrent chemotherapy and radiation
  • Metastatic disease
  • Adjuvant treatment following curative surgery
  • Recurrence following previous treatment

(Patients on surveillance after previous treatment for lung malignancy may be referred directly to Respiratory Department)

Category 2
(appointment within 90 calendar days)
  • Patients with previously treated lung cancer
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

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

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

 

Essential referral information for Pulmonary nodules referrals (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

Specialist Essential Referral Information:

  • Tissue pathology +/- cytology results
  • Physiological assessment - pulmonary function test if applicable
  • Bronchoscopy including endobronchial USS (EBUS) [3] if applicable
  • CT chest, upper abdomen and pelvis
    • if available attach CT or MRI of the brain and bone scan
  • PET scan reports for selected patients

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Pulmonary nodules referrals

Nil.

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 17 May 2024