Aim and Setting:
Our study was designed to analyse time delays in management pathways of rural versus urban lung cancer patients and explore patients’ perspective of factors causing these delays. Lung cancer patients presenting to Townsville, Cairns and Mackay cancer centres, Australia were prospectively recruited from 2009 to 2012. Times along referral pathway were divided as below: Onset of symptoms to treatment (T1), Onset of symptoms to general practitioner (T2), GP to specialist referral (T3), and Specialist to diagnosis (T4). Appropriate analyses were conducted using SPSS version 2015. Perspectives of patients on delays were collected via short interviews and analysed using thematic analysis.
Results:
252 patients were recruited for the study. On multivariate analysis, T1 was influenced by remoteness (125 days in Townsville vs 148 in Cairns and Mackay vs 170 days for Remote, p=0.01). T2 was influenced by level of education (91 days for Primary education vs. 61 days for Secondary vs 23 days for Tertiary/TAFE, p=0.006), age group (14 days for 31-50 years, 61 days for 51-70 years, 45 days for >71 years, p=0.026). T3 was influenced by remoteness (15 days for Townsville, 14 days for Cairns, 29.5 days for remote, p=0.02). T4 was influenced by stage of disease ( 21 days for stage I, 11 days for Stage II, 34 days for Stage III 18 days for Stage IV, p=0.041). Common reasons for delays perceived by rural patients were: competing priorities of caring for family and work, inconvenience of travel for chemotherapy and appointments and financial difficulties.
Conclusion:
Remoteness and level of education contribute to delays in various referral points in lung cancer referral pathway. Several socioeconomic factors were perceived as barriers to timely access to care. Education campaign targeted at rural populations and creation of systems to provide specialist services closer to home may decrease delays.