LEAD - Lung cancer

LEAD - Lung cancer diagnostic and treatment pathways: A comparison between Culturally and Linguistically Diverse (CALD) and Anglo-Australian patients

Welcome to the second issue of the " LEAD - Lung cancer diagnostic and treatment pathways: A comparison between Culturally and Linguistically Diverse (CALD) and Anglo-Australian patients" project newsletter!

LEAD is funded by Cancer Council Australia with the assistance of Cancer Australia through the 2015 round of the Priority-driven Collaborative Cancer Research Scheme. The aim of LEAD is to explore the diagnostic and treatment pathways among lung cancer patients in multicultural Australia. We are currently recruiting participants across the ten participating hospitals.

Background

Lung cancer is the leading cause of cancer mortality worldwide. In Australia lung cancer kills more people than breast, prostate and ovarian cancer combined. Culturally and linguistically diverse (CALD) patients are especially vulnerable with higher mortality rates than Anglo-Australian patients. Reasons for this are unclear as there is no Australian specific data examining the barriers existing along the lung cancer pathway from symptom appraisal to treatment in CALD populations. 
LEAD addresses this gap by comparing the diagnostic and treatment pathways between Anglo-Australian and CALD lung cancer patients in Melbourne, Sydney and Brisbane and by exploring the reasons for differences between these two groups. It is built upon previous cohort studies undertaken in the UK and rural Australia, as well as evidence based guidelines encouraging early diagnosis of lung cancer developed by members of the research team. 

Aims

The aims of the LEAD are to:

  • Measure, compare and contrast the diagnostic and treatment pathways between CALD and Anglo-Australian lung cancer patients.
  • Identify patient healthcare provider and health system factors that influence the pathways in CALD and Anglo-Australian lung cancer patients.

Significance

This project, endorsed by the Primary Care Collaborative Cancer Clinical Trials Group (PC4), is the first Australian study to provide comprehensive data on the diagnostic pathway for lung cancer in CALD and Anglo-Australian patients. This information is vital in understanding the difference in health outcomes between CALD and Anglo-Australian patients with lung cancer and can be used to design future interventions that aims to improve early diagnosis and health outcomes among lung cancer patients. 

Funding information

LEAD is funded by Cancer Council Australia with the assistance of Cancer Australia through the 2015 round of the Priority-driven Collaborative Cancer Research Scheme.

What does LEAD involve?

LEAD uses a mixed-methods, observational cohort study design.

Quantitative arm

The quantitative arm comprises case-note analysis of hospital and general practice records and patient symptom questionnaires. Participants of the quantitative component are Anglo-Australian and CALD lung cancer patients, and their GPs. For CALD patients, we are recruiting patients from Arabic, Chinese, Greek, Italian, and Vietnamese. These CALD communities are targeted because they are the five top CALD communities for overseas-born people in Australia. 

Qualitative arm

The qualitative arm comprises interviews with lung cancer patients, General practitioners (GPs) and hospital specialists.

Where is LEAD being conducted?

LEAD is currently being conducted in five sites with ten participating hospitals across three states, including:

  • the Southern Melbourne Integrated Cancer Service (SMICS, with two participating health services including Monash Health and Alfred Health), the North-Eastern Melbourne Integrated Cancer Service (NEMICS, with three participating health services, including Austin Health, Eastern Health, and Northern Health ) and the Western and Central Melbourne Integrated Cancer Service (WCMICS, with three participating health services, including Melbourne Health, Peter MacCallum Cancer Centre, and Western Health) in Victoria,
  • the Royal Prince Alfred Hospital (RPAH) in NSW, and
  • the Princess Alexandra Hospital (PAH) in Queensland
  • the Princess Alexandra Hospital (PAH) in Queensland.

Project progress

Current progress

As of November 2018,

  • a total of 3, 331 patients were screened
  • 577 patients met the inclusion criteria including 407 Anglo-Australian patients and 170 patients from the five target CALD communities.
  • a case-note analysis of hospital medical records were conducted for all eligible patients.
  • 189 patients (response rate: 33%) returned the survey, including 135 Anglo-Australian patients and 54 CALD patients.
  • 156 (consent rate: 83%) patients provided consent for the research team to contact their GPs.
  • 99 GPs (response rate: 63%) returned the GP review form for their patients
  • interviews have been conducted with 32 patients (15 Anglo-Australians and 17 CALD), 17 GPs, and 18 hospital staff.

What is next?

We are analysing data and drafting journal papers. It is expected that at least four papers will be drafted and submitted to relevant journals by the end of 2019.

Project team

The multidisciplinary research team consists of:

  • Professor Danielle Mazza (Monash University),
  • Professor Jon Emery (University of Melbourne)
  • Dr Fiona Walter (Cambridge University)
  • Professor Jane Young (University of Sydney)
  • Professor David Barnes (Royal Prince Alfred Hospital)
  • Associate Professor Paul Mitchell (Austin Health)
  • Dr Bianca Brijnath (Curtin University)
  • Dr Andrew Martin (University of Sydney)
  • Professor Kwun Fong (Prince Charles Hospital)
  • Dr Robert Stirling (Alfred Hospital)
  • Dr Peter Briggs (Monash Health)
  • Dr Chan Cheah (Consumer representative)
  • Ms Geraldine Largey (Southern Melbourne Integrated Cancer Service)
  • Professor Ken O’Byrne (Queensland University of Technology)
  • Dr Zarnie Lwin (University of Queensland & Mater Health Services).
  • Professor Mazza chairs this group of researchers and has overall responsibility for the project including completion of the project and project deliverables. Under the supervision of Professor Mazza, the project manager, Dr Xiaoping Lin, oversees the day to day activities of the project.


    Contact details:
    For more information please contact the Project Manager:
    Dr Xiaoping Lin
    E: xiaoping.lin@monash.edu
    T: (03) 9902 4481