For Referring Physicians

Referral information

We are pleased to accept referrals for known or suspected thoracic malignancies, structural lung disease including central airway obstruction, hemoptysis, unexplained dyspnea in a cancer survivor or in a patient with active cancer, and cancer survivors with persistent respiratory symptoms or need for ongoing imaging surveillance.

Lung cancer or suspicious thoracic lesions

The Grand River Regional Cancer Center (GRRCC) Lung Diagnostic Assessment Program (LDAP) is happy to receive your referrals for suspected malignancy or pulmonary nodules.

For suspected malignancy, we will review the case through our radiology review program within 48h of referral. Upon review, appropriate staging scans will be immediately ordered. If your patient has a high-risk lesion, they will be contacted by telephone to offer entry into our QuickStart EBUS program for an accelerated biopsy before their initial consult. This program is intended to minimize the amount of time patients have to wait for a diagnosis in what is often a stressful time in their lives.For some patients, a biopsy before speaking to a physician may not be desirable. If patients decline this option, it will not delay their initial consultation in any way. In addition, patients will still have access to the first available biopsy slots if they subsequently consent after speaking to an LDAP physician.

Thoracic malignancy referrals

The Kitchener Waterloo LDAP program is pleased to accept any referrals for suspected or confirmed thoracic malignancy on computed tomography (CT) of the chest. Referrals for an abnormal CX are accepted as well and we will order a chest CT for these patients upon receiving your referral. We would prefer all referrals be sent immediately and you do not need to order further imaging or a biopsy. Dr. Burkett will review the case and imaging within 48 hours and our required staging imaging, including a PET scan if indicated, will be ordered at that time by Dr. Burkett. If malignancy is suspected, your patient may be contacted by phone to arrange a biopsy if they consent especially if we are not able to see them in consultation quickly as our goal is to rule out cancer or have your patient obtain a diagnosis and see an oncology specialist in the shortest time possible. If your patient does not consent to up front testing, they will still be offered a consultation in the shortest amount of time possible and will still have access to the first available biopsy slots if they consent after the discussion during their consultation.

At this time, we are only able to accept referrals for out patients and a referral for suspected malignancy can be sent on their day of discharge. If you believe your admitted patient requires an urgent malignancy workup, please page Dr. Burkett directly through the Grand River Hospital locating system to discuss the case.

KW malignant pleural effusion clinic

The MPE clinic offers dyspnea management, support and counselling for patients with malignant pleural effusion. The MPE clinical team includes a Respirologist and a registered nurse.

The PleurX catheter is indicated for the palliation of malignant pleural effusion. Home Care nurses will conduct regular assessments of the patient, and conduct intermittent drainage of pleural fluid as necessary in the home. The PleurX catheter is a one way valve indwelling silicone catheter for intermittent fluid drainage. This catheter has been reported to be highly effective with low risk of complications in the palliative treatment of malignant pleural effusion.

Referral criteria for the clinic:
  • Documented pleural effusion (CT or X-Ray)
  • Documented or suspected cancer diagnosis
Referrals for undifferentiated pleural effusions not highly suspicious for malignancy should be sent to Dr. Burkett directly.

For malignant effusions, temporary pleural drains such as pigtail catheters or surgical chest tubes are contraindicated as they limit the ability to perform future pleural interventions. We are unable to accept referrals for patients with current pleural drain and these patients should be referred back to the physician who placed the drain for ongoing management.

Referrals to the MPE clinic can be faxed to: 519-749-4384

Benign or undifferentiated effusions

Respirologists and thoracic surgeons at the IPMSWO provide comprehensive, specialized care for patients experiencing pleural effusion. Their expertise can provide patients with a highly informed diagnosis and a cohesive treatment plan. Should surgery or a procedure be required, our surgeons and interventional respirologists are experts in the latest minimally invasive thoracic techniques such as ultrasound-guided thoracentesis, indwelling pleural catheter placement and video-assisted thoracic surgery (VATS), a safe and effective alternative to open surgery.

Referrals for benign or undifferentiated effusions should be sent to Dr. Burkett directly (F: 519-749-4384).

Cancer related dyspnea

Cancer related dysnpea can often be one of the most challenging symptoms to manage. We provide a comprehensive work up for the cause of the symptoms and, when necessary, may offer minimally invasive interventional respirology procedures to alleviate symptoms.

Referrals for dyspnea in a cancer survivor or patient with an active malignancy can be sent to Dr. Burkett directly (F: 519-749-4384).

Thoracic malignancy survivors

Cancer survivors often have a unique set of physical and psychological symptoms that may arise or persist after their treatments have ended causing significant anxiety for patients and their care providers. Occasionally, this can lead to unnecessary imaging or testing which can cause potential complications for patients. 

In our survivorship clinic, we hope to reassure patients and avoid invasive testing or repeat imaging where appropriate, while expediting the work up of new potentially serious symptoms or findings.

Referrals for survivorship clinic can be faxed to Dr. Burkett directly (F: 519-749-4384).

Structural lung disease/hemoptysis

Urgent referrals for hemoptysis or unexplained structural lung disease on CT can be sent to Dr. Burkett directly.