Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer – Review of International Options and Considerations for Greece

Figures & data

Table 1 Patient Flow Through the PNC

Pre-Visit
Step 1	Specialized nurse or navigator collects focused history, gathers images and communicates with referring medical doctor (MD)
Step 2	Multidisciplinary team reviews images, decides which MDs will see patient at first appointment
Initial Appointment
Step 3	Designated MDs see patient
Step 4	Images are reviewed with patient
Step 5	MDs offer tobacco cessation program
Step 6	Recommended procedures are planned
Follow up
Step 7	Navigator ensures scan follow up and scheduling of all procedures
Step 8	Navigator schedules all follow-up visits
Step 9	If no procedures need to be planned, patient consults with specialized nurse
Discharge
Step 10	Criteria: no further scans are required, >2 years stable, future procedures are planned
Step11	Navigator documents discharge in medical record and updates referring physician

Notes: Data from Roberts TJ, Lennes IT, Hawari S, et al. Integrated, multidisciplinary management of pulmonary nodules can streamline care and improve adherence to recommendations. Oncologist. 2020;25(5):431-437. doi: 10.1634/theoncologist.2019-0519.14

Table 2 Comparison of PNCs in the US and the UK

Parameter/Service	US	UK
Scheduling initial appointment	Coordinator/Nurse	Referral by Trust/GP
Medical history (call/virtual/F2F)	Call/virtual/F2F	Call/virtual/rarely F2F
Compilation of past imaging results	Coordinator/Nurse	Coordinator/Nurse
Review of results	MDT	MDT
Follow-up plan	MDT	MDT
Follow-up meeting with patient	Specialist	Nurse/letter to GP/patient
Tobacco cessation services	Within PNC	Referral to specialized service within NHS through GP
Scheduling of additional tests, etc.	Coordinator/Nurse	GP