Timely referral and commencement of treatment for lung cancer can improve survival. Australian and British guidelines recommend time intervals from General Practitioner (GP) referral to first Lung Cancer Specialist (LCS) appointment, and then from diagnosis to treatment, each occur within 14 days. However, data are scarce and difficult to interpret due to inconsistent timeline definitions.
To determine time intervals in lung cancer care milestones using standardised definitions.
Using a validated six-stage framework, we conducted a scoping review to determine time intervals to lung cancer care. Eligible studies were identified from Medline, PubMed and Embase databases, web sources and hand searches of reference lists and grey literature. The primary endpoint was GP - LCS interval. Performance against timeframe recommendations and rapid referral systems was compared. Factors responsible for delays were explored. Descriptive statistics were used for analysis and non-parametric Wilcoxon Rank Sum Tests compared time intervals in studies reporting rapid referral systems.
Of 744 identified studies, 101 full-text articles were eligible for data extraction. Studies were conducted from 1980-2015, in 7 geographical regions, including 73% NSCLC and 18% SCLC patients. GP-LCS interval was only reported in 30/101 (30%) studies. The median GP-LCS interval was 7 days (range 0 – 56), with 3/30 (10%) studies >14 days. Median time from diagnosis to treatment was 24 days (8 – 80); with 89% >14 days. Delays were commonly attributed to patient factors and poor coordination of medical services to obtain a diagnosis at the secondary care level. There was no evidence of shorter GP-LCS intervals in regions using rapid referral systems (P = 0.93).
Waiting times to see a LCS met target timeframes in most regions. Times to treatment within secondary care could be improved. Heterogeneity in study design and outcome measures limits synthesis and interpretation of literature.