Intended for healthcare professionals

Feature The BMJ

Cancer care team

BMJ 2016; 352 doi: (Published 15 March 2016) Cite this as: BMJ 2016;352:i1443
  1. Nigel Hawkes, freelance journalist
  1. London, UK
  1. nigel.hawkes1{at}

Creative thinking by nominees for our Cancer Care Team Award is reducing hospital stays speeding up diagnosis, and providing better support, Nigel Hawkes reports

Ambulatory lung biopsy service

Treatment for lung cancer is improving, but too many patients are failing to benefit because of delays in diagnosis or the reluctance of hospitals to do lung biopsies for fear of a common complication, a collapsed lung (pneumothorax). So says Sam Hare, consultant thoracic radiologist at Barnet Hospital, who drew on experience of a thoracic fellowship in Canada to transform the patient pathway.

A key step was to remove fears about biopsies by using the Heimlich valve chest drain, a small portable device that can be inserted in the event of pneumothorax, allowing patients to go home. The traditional bulky drain typically requires a one to two day hospital stay, which meant that many frail patients were denied biopsies because of fears about prolonged admission. Even when offered biopsies, many turned them down for the same reason.

“We never decline a lung biopsy,” Hare says. “Our patients don’t need beds; they usually go home in 30 minutes. If there is a collapsed lung, they can still go home—it’s a minor, treatable inconvenience rather than a catastrophe. Most places do 30 biopsies a year—this year we’ll do 300. Patients like it—waiting for a diagnosis is a difficult, anxious time.

“We’re doing biopsies on patients other hospitals say no to, those with smaller cancers deep in the lung or with …

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