Aim A new pathway to enable quicker lung cancer diagnosis for the 4 district health boards within one of the cancer networks in New Zealand was developed incorporating rapid access clinics (RACs), with upfront PET-CT scans for those considered potentially curable at initial assessment.
Methods In this 12-week pilot, patients graded as high suspicion of lung cancer were seen in RACs with spirometry, performance status assessment and available radiology (chest X-ray or CT scan). Those considered potentially curable by surgery or radiotherapy (FEV1 ≥1 litre, ECOG score <2, no evidence of mediastinal lymphadenopathy or metastasis on imaging, no comorbidities precluding radical treatment) received an upfront PET-CT scan; those who were not received a standard CT scan if not already done. These protocols were based on the virtual model proposed by the Gleeson group, Oxford, UK.1 Time through the pathway was measured and compared with historical data from the regional lung cancer database in a 6 month period the year before the pilot.
Results One hundred and sixty five patients completed the pathway, of which 105 were found to have lung cancer. Forty one patients had upfront PET-CT scans; 30 were confirmed as lung cancer, 7 of which subsequently had palliative treatment. Eleven had non-lung cancer diagnoses (9 not cancer or nodule follow up; 1 metastasis; 1 other cancer). Seventeen patients had PET-CT scans later in the pathway, 4 of which subsequently had curative treatment. Median time from referral to first treatment was reduced by 16.7 days (patients with curative treatment intent 17.2 days and palliative treatment intent 12.7 days), significantly reducing both the time from referral to multidisciplinary meeting (MDM) and MDM to first treatment. Achievement of 62-day target referral to treatment targets was 85.7% compared with 56.6% in the historical data.
Conclusion A regional lung cancer pathway incorporating RACs and upfront PET-CT scans for curative track patients resulted in improvements in diagnostic delays and 62-day treatment targets. These findings subsequently led to implementation of this pathway regionally.
The study was funded by a New Zealand Ministry of Health project grant
Macpherson R, et al. A proposed new imaging pathway for patients with suspected lung cancer. Clin Radiol 2012;67(6):564–73.
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