Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation.

Surgery may be suitable for patients:

• with early-stage NSCLC who are fit for the required surgery
• requiring surgical diagnosis or palliation.

Radiation therapy may be suitable for patients with:

• early-stage (I–II) NSCLC who are unsuitable or unwilling to have surgery
• locally advanced (III), inoperable NSCLC
• limited stage (I–III) SCLC who are undergoing combined modality treatment with chemotherapy or who may benefit from prophylactic cranial irradiation.

All patients with NSCLC and SCLC may benefit from radiation therapy for palliative intent.

Local ablative therapies may be an alternative to curative or palliative therapy in some patients:

• with localised NSCLC who are unsuitable for surgery or radiation therapy
• with oligometastatic NSCLC who are unsuitable for surgery or radiotherapy
• undergoing multi-modality treatment in combination with radiotherapy, chemotherapy or immunotherapy.

Oligometastatic disease refers to a clinical situation where there are a limited number of metastatic tumours that could potentially be managed with curative intent. Refer appropriate cases to centres with expertise in this area.

Systemic therapy may be suitable for patients with:

• advanced disease and good performance status
• NSCLC who are undergoing neoadjuvant or adjuvant therapy in conjunction with complete resection of locoregional disease
• inoperable, localised NSCLC who are suitable for combined modality definitive chemoradiation
• SCLC.

Palliative care

Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Begin treatment within 6 weeks of the initial specialist referral. Medical emergencies should follow guidelines.