There is limited evidence for the optimal management of lung cancer with specific regard to timeline from general practitioner referral to specialist workup and treatment. The Cancer Council Victoria developed an optimal care pathway for lung cancer in 2014, recommending that first specialist appointment should be within 14 days, and initial treatment should be no more than 42 days from initial referral.
In this study, we aimed to compare the quality of care of management of lung cancer patients at our institution to optimal care pathway guidelines, including different definitive treatment modalities.
We performed a retrospective chart review to evaluate the timeframe from initial referral to specialist consultation and initial definitive treatment for all patients diagnosed with primary lung cancer in 2016 at our institution. The data was obtained from the electronic medical record and AusCare pathology software. Patients were excluded if they were on lung nodule surveillance, their primary cancer was mesothelioma or if they experienced a prolonged diagnostic course due to an initial diagnosis of pneumonia.
Overall, 121 patients were included in our audit. The mean time from referral to initial specialist appointment was 9.3 days overall, but 15.3 days in the subgroup that waited for outpatient appointment rather than presenting to the emergency department. The mean days to treatment was 43.8 days for chemotherapy, 46.1 days for radiotherapy and 55.1 days for surgery. The percentages of patients meeting optimal care pathway guidelines were 78.5% for initial consultation, 45.6% for chemotherapy, 36.3% for surgery and 45.7% for radiotherapy treatments, respectively.
These results suggest that at our institution, many patients are receiving initial management within the timeframe of the lung cancer optimal care pathway, but there is room for significant improvements to be made.