GP Connect Clinical Feature by Dr. Jessica Nash, MBBS (Hons), MPH, FRACP, PhD Candidate, Curtin University, Respiratory Physician, Sir Charles Gairdner Hospital
Lung cancer is one of Australia’s most common cancers and is the leading cause of cancer-related death. Despite evolution in lung cancer treatment, five-year survival remains very low, at 24 percent. This reflects that most patients have metastatic disease at the time of diagnosis.
The implementation of the National Lung Cancer Screening Program in July 2025 will lead to earlier detection and improved outcomes for high-risk individuals who meet the eligibility criteria. However, clinicians must remain alert to the possibility of lung cancer diagnosis in patients who do not have a history of tobacco exposure.
Lung cancer in patients who have never smoked is the fifth leading cause of cancer death worldwide, and the importance of other risk factors including genetic risk and air pollution are increasingly recognised.
Patients with symptoms such as haemoptysis, persistent new or changed cough, chest pain, or unexplained weight loss require prompt evaluation regardless of tobacco exposure or screening eligibility.
Multidisciplinary team (MDT) care is crucial for patients with suspected or confirmed lung cancer. In the Optimal care pathway for people with lung cancer, Cancer Australia recommends referral to a clinician – in practice, usually a respiratory physician – linked to a thoracic MDT. In Perth, the three major public hospitals, as well as St John of God Midland Public Hospital and some private hospitals, have a regular Thoracic Multidisciplinary Meeting (MDM). GPs can also refer to the Multidisciplinary Thoracic Malignancy Assessment referral pathway on Clinician Assist WA for service information. Many clinicians working in private practice will be affiliated with a private hospital MDM, although their staffing may vary, as in the public system.
Lung cancer diagnosis and staging is complex and routinely requires the utilisation of multiple modalities, including Positron Emission Tomography/Computed Tomography (PET/CT) imaging (nuclear medicine), percutaneous biopsy (interventional radiology) and/or bronchoscopy (respiratory medicine). Anatomical and molecular pathology play an important role, not only in confirming the diagnosis, but performing additional tests to identify driver mutations that determine which treatment regimens are likely to be most effective. The optimal care pathway includes timelines for lung cancer diagnosis and treatment commencement, although meeting these targets is challenging.
Discussion at a thoracic MDM is vital for all patients with suspected or confirmed lung cancer. This is where cancer stage is confirmed – which may require additional testing, such as mediastinal lymph node staging – and a personalised treatment recommendation is made. MDM discussion is associated with an overall survival benefit, regardless of cancer stage. The optimal care pathway provides recommendations for minimum and extended MDM staffing; engagement of all core disciplines is required to ensure robust decision making. This includes consideration of newer treatment approaches, particularly for patients diagnosed with non-small cell lung cancer. Examples of recent advances adopted as best practice care in WA include lung-sparing approaches for select patients undergoing surgical resection; increasing use of systemic therapies in the perioperative setting, and the utilisation of Next Generation Sequencing, which may enable access to highly effective targeted therapies or clinical trials.
Involvement of general practice is key to good multidisciplinary care and is important at all stages of cancer diagnosis and treatment. Ensuring that referrals for patients with suspected lung cancer contain requisite the information will assist in expediting diagnostic workup: this should include an up-to-date medical history and medication list (particularly antiplatelets and anticoagulants), details of diagnostic imaging (i.e. CT chest; chest x-ray is not sufficient) and other relevant investigations, such as echocardiogram results. GP involvement will also ensure adequate psychosocial support during diagnostic testing and prior to treatment; this period can be a time of significant uncertainty and anxiety for patients and families. Open communication between MDTs and the patients’ usual GPs should include regular updates regarding diagnostic confirmation, MDM outcomes and treatment, as well as discussion of potential shared care arrangements and follow-up care. This is of particular relevance for patients who elect not to receive anti-cancer therapy and may have increased need for supportive and palliative care in the community.
In summary, multidisciplinary input is essential when caring for patients with suspected and confirmed lung cancer, particularly in light of evolving treatment paradigms. Referral to a clinician affiliated with an experienced thoracic MDT is critical to ensure best practice diagnostic testing and staging, and a personalised treatment recommendation that provides patients with the best chance of cure (where possible), or otherwise durable disease control with preserved quality of life.
Resources for GPs:
Clinician Assist WA clinical and referral pathways:
- Lung Cancer – Suspected
- Multidisciplinary Thoracic Malignancy Assessment
- Psychosocial Care in Cancer
Cancer Australia and Cancer Council:
- Optimal care pathway for people with lung cancer – 2nd edition
- Optimal care pathway for people with lung cancer – quick reference guide
Australian Government Department of Health and Aged Care:
Dr. Jessica Nash is conducting focus groups exploring the best way to feedback information regarding the quality of lung cancer care. If you would like more information, or are interested in participating, please contact Jessica at Jessica.nash@curtin.edu.au.