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Abstract
Introduction and objectives Cancer waiting times (CWT) targets have helped hospital services evolve to meet the needs of Lung Cancer patients. However, these outcomes are adjusted to allow for perceived clinical complexity or deviation from a ‘standard’ diagnostic journey. Few patients breach CWT targets in our unit. We performed a retrospective audit to determine the actual time our patients spent on diagnostic pathways and how this related to disease stage and survival.
Methods 377 consecutive patients who presented with Lung Cancer during 2013 were identified from our MDT database. 243/377 (64%) presented as an inpatient and were excluded. 22/134 GP referrals were excluded (insufficient records, aborted investigation (clinical deterioration, patient preference), incomplete staging) leaving 112 cases. Demographics, histology, referral-to-treatment (RTT), referral-to-diagnosis (RTD) and diagnosis-to-treatment (DTT) times were recorded. Overall Survival (OS) based on RTT times and Stage was assessed using Kaplan-Meier methodology.
Results 82/112 (73.2%) patients had non-small cell lung cancer, 18 (16.1%) had small cell lung cancer and 12 (10.7%) were radiologically-diagnosed. 48/112 patients (42.9%) had stage I to IIIA disease. Mean RTD, RTT and DTT times were 43 (SD 55), 69 (SD 45) and 26 (SD 51) days, respectively.
a) Univariate Survival analysis based on Referral to Treatment time < or > 62 days in 112 patients with Lung Cancer (all stages) b) Univariate Survival analysis based on Referral to Treatment time < or > 62 days in 48 patients with potentially radically treatable Stage I-IIIA Lung Cancer
RTD time was <31 days in 57/112 cases (50.8%). 31.6% of these were Stage I-IIIA, compared with 54.5% Stage I-IIIA when RTD was >31 days.
RTT time was <62 days in 59/112 cases (52.7%). 25.4% of these were Stage I-IIIA, compared with 62.3% Stage I-IIIA when RTT was >62 days.
RTT time was <62 days in 15/48 (31.3%) Stage I-IIIA patients and <62 days in 44/64 (68.8%) patients with Stage IIIB-IV.
Conclusions Despite few CWT breachers, RTT times were frequently >62 days suggesting pathway adjustments have a major impact. Patients with earlier stage disease, and the most to lose from diagnostic delay had longer diagnostic journeys. The survival disadvantage of short pathways likely reflects stage mix. Pathway redesign to accelerate the complex diagnostics needed for radically-treatable disease should be considered. CWT adjustments may have unintentionally clouded this issue.