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Lung Cancer

Emergency department referrals

Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.

Contact on call Oncology Registrar through:

  • Royal Brisbane & Women’s Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

View the emergency contact details for referring General Practitioners.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Significant bleeding – including haemoptysis
  • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
  • New findings of symptomatic brain metastasis or leptomeningeal disease diagnosed in the community
  • Suspected spinal cord compression or cauda equina syndrome
  • Symptoms of airway obstruction / compromise or Superior vena cava obstruction
  • Symptomatic malignant hypercalcaemia
  • Patients with a visceral crisis from suspected but not confirmed malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Patients with suspected lung cancer should be referred to the Respiratory team for evaluation and further investigation. Patients are usually then presented in a multi-disciplinary meeting for treatment planning and further referral if required for Medical Oncology input.

  • All small cell lung cancer that does not need emergency treatment (see Emergency Referrals). For optimum care, patient should be seen within 2 weeks.
  • Biopsy proven advanced non-small cell lung cancer (preferably seen within 2 weeks)
  • Neoadjuvant treatment prior to curative surgery
  • Locally advanced disease for concurrent chemotherapy and radiation
  • Adjuvant treatment following curative surgery
  • Recurrence following previous treatment (Patients on surveillance after previous treatment for lung malignancy may be referred directly to medical oncology)

Category 2

Appointment within 90 days is desirable

  • Patients with previously treated stage 3 or stage 4 lung cancer requiring ongoing follow-up for five years post-diagnosis
  • Transfer of care from another health service

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • 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

Other important information for referring practitioners

  • Refer to local HealthPathways or local guidelines
  • Suspected lung cancer (mass on chest XR or CT chest) needs to be referred to the appropriate specialist (usually respiratory physician) for work-up. Specialist review optimally should be within 2 weeks.
  • Most referrals for locally advanced disease for concurrent chemotherapy and radiation come through respiratory or cardio-thoracic team and after (Multidisciplinary Team) 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.
  • If the referring clinician organises a biopsy – please ensure a core or excisional biopsy (not a FNA) is performed
  • Patients with some stages of lung cancer may receive chemotherapy and immunotherapy as their first cancer treatment / as neoadjuvant therapy prior to surgery. However, the referral for initial assessment should be made to the Respiratory service, not medical oncology, for evaluation and management planning initially.
  • Histology (biopsy or surgical specimen) for Non-small cell lung cancer usually include testing for common lung cancer mutations, and translocations and PDL1 immunohistochemistry
  • Serum tumour bio-markers should not be used as diagnostic tests
  • For women and men who have not completed their family, fertility preservation needs to be discussed
  • 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 woman’s prognosis and their understanding of their prognosis
    • whether Advanced Care Planning (ACP) conversations have been undertaken and their outcome
    • specific patient goals and values that may impact on treatment choices, and
    • whether the patient has been referred to a palliative or supportive care service.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

General Practitioner

  • Past medical history, current medications
  • Smoking history
  • Previous cancer treatment details
  • FBC, U&E, LFTs results
  • Any relevant XR results =/- relevant CT reports
    • CT chest, upper abdomen and pelvis
  • Tissue pathology +/- cytology results

Specialist Essential Referral Information

  • Include GP essential referral information
  • Tissue pathology +/- cytology results
  • Physiological assessment – pulmonary function test (if applicable)
  • Bronchoscopy including endobronchial USS (EBUS) (if applicable)
  • PET scan reports for selected patients

Out of catchment

Metro North 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 North 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.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • 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

  • 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
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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