Biopsy proven new diagnosis of lymphoma
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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Emergency treatment required - needs discussion with on call specialist and/or emergency department.
- Symptoms of airway obstruction, SVC obstruction
- Severe gastrointestinal (GI) bleeding
- Bowel obstruction
- Febrile neutropenia
- Symptomatic hypercalcaemia
- Other organ failure/dysfunction
- Uncontrolled and disabling pain
- Massive haemoptysis and/or stridor
- Neurological signs suggestive of brain metastases or cord compression
- Very high calcium (3.0mmol/L)
- Severe dysphagia with dehydration
- Biopsy proven small cell lung cancer
- patients with symptoms of shortness of breath, deteriorating organ function
- Metastatic germ cell tumour (GCT) confirmed (biopsy) or suspected (tumour markers)
- Patients with severe symptoms, organ failure or life threatening complications
- Highly aggressive lymphoma
- Burkitt's lymphoma
- lymphoblastic lymphoma
- Acute leukaemia
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| Category 1 (appointment within 30 calendar days) |
# If any life threatening symptoms present (new hypercalcaemia) or severe or life threatening symptoms present (e.g. spinal cord compression, SVC compression, ureteric compression, airway compromise etc.) – then call the haematologist on call, or send direct to emergency.
|
| Category 2 (appointment within 90 calendar days) |
|
| Category 3 (appointment within 365 calendar days) |
|
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- 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
2. Essential referral information Referral will be returned without this
- General referral information
- Detailed history of present signs and symptoms
- Past medical history/pertinent social history
- Current medications and allergies
- Histology report
- FBC U&E LDH results
3. Additional referral information Useful for processing the referral
- Histological diagnosis does not necessarily predict clinical behaviour and as such, some low grade lymphomas may be treated as Cat 1 urgent and some aggressive lymphomas may be treated as Cat 2. This decision should always be made on clinical assessment
4. Request
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Patient's Demographic Details
- 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
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- 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
Reason for request
- 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
Clinical modifiers
- 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
Other relevant information
- 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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If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
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Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
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A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
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Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
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Last updated: 25 May 2017
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