Impact of rapid investigation clinic on timeliness of lung cancer diagnosis and treatment

Ezer, Nicole; Navasakulpong, Asma; Schwartzman, Kevin; Ofiara, Linda; Gonzalez, Anne V.

doi:10.1186/s12890-017-0504-5

Cited by 15 publications

(14 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This could be linked to higher symptom severity or FPs may be using the ED as a means for quicker access to a specialist due to a lack of integration between primary and specialist care [ 28 ]. Rapid investigation clinics were implemented in Québec to fast-track diagnosis of patients with suspected lung cancer; however, our study suggests that these are not used as intended [ 29 ]. Québec also recently implemented an electronic referral system to improve access to specialists.…”

Section: Discussionmentioning

confidence: 99%

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

et al. 2021

View full text Add to dashboard Cite

Background: Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral. Methods: In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (n = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities. Results: 68% of the patients followed a pathway where family physician (FP) visits were dominant (“FP-centric”) and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant (“ED-centric”). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12–111) vs. 22 (IQR: 5–69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit. Conclusions: Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.

show abstract

Section: Discussionmentioning

confidence: 99%

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Rapid LC diagnostic units have proven to be very useful, although audits are necessary to evaluate them. 11,26,[30][31][32] In some series, a specific rapid diagnosis program has reduced the delay from 128 to 20 days for the entire management process and significantly reduced the delays to access a specialist or undergo a scan, a bronchoscopy, or PET-CT. 17 Nurse navigation has also improved the time from suspicion of LC to treatment with a trend toward diagnosing non-small cell lung cancer at an earlier stage, both in our study and in previous series. 33 Based on our results, we suggest some areas for improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid LC diagnostic units have proven to be very useful, although audits are necessary to evaluate them . In some series, a specific rapid diagnosis program has reduced the delay from 128 to 20 days for the entire management process and significantly reduced the delays to access a specialist or undergo a scan, a bronchoscopy, or PET‐CT .…”

Section: Discussionmentioning

confidence: 99%

Predicting delays in lung cancer diagnosis and staging

et al. 2019

View full text Add to dashboard Cite

BackgroundDespite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions.MethodsWe analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded.ResultsMalignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03).ConclusionsA greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.

show abstract

“…e Rapid Investigation Clinic (RIC) was established in 2010 to improve and accelerate the investigation of patients with suspected lung cancer [11], and a prospective database of all patients evaluated at the RIC has been maintained. An institutional registry of all patients with a pathological diagnosis of lung cancer was established in 2008. ese two databases were cross-referenced to identify patients investigated at the RIC, and in whom a diagnosis of lung cancer was confirmed, between January 1 st , 2015, and June 30 th , 2016. e CT scan of the chest that triggered additional investigations for suspected lung cancer was considered the initial CT scan.…”

Section: Methodsmentioning

confidence: 99%

“…This was a retrospective study. The Rapid Investigation Clinic (RIC) was established in 2010 to improve and accelerate the investigation of patients with suspected lung cancer [ 11 ], and a prospective database of all patients evaluated at the RIC has been maintained. An institutional registry of all patients with a pathological diagnosis of lung cancer was established in 2008.…”

Section: Methodsmentioning

confidence: 99%

An Audit of CT Chest Reports and Their Potential Impact on the Workup of Patients with Suspected Lung Cancer

Weinstock

Jeagal

Savard

et al. 2021

Canadian Respiratory Journal

Self Cite

View full text Add to dashboard Cite

Background. Quality gaps exist in the diagnostic evaluation of lung cancer patients. The initial CT chest guides the workup of patients with suspected lung cancer. We sought to determine how frequently CT reports provided guideline-concordant recommendations with regard to additional imaging studies and/or invasive diagnostic procedures. Methods. This was a retrospective study. The records of patients referred for investigation of suspected lung cancer between January 1, 2015, and June 30, 2016, were reviewed. Patients with confirmed lung cancer, for whom CT scan images and reports were available, are included. CT reports were reviewed, with attention to additional imaging studies and/or invasive diagnostic procedures suggested. These recommendations were examined against current guidelines for lung cancer diagnosis and staging, based on suspected disease stage. Results. One hundred forty-six patients are included in the analysis. Most patients were diagnosed with non-small-cell lung cancer (NSCLC), and 63% had advanced disease (stages III and IV). Only 12% of CT reports contained guideline-concordant recommendations for additional imaging studies, with PET scan suggested in only 6% of reports. Potential invasive diagnostic procedures were suggested in one fifth of CT reports, and only 58% of these recommendations were in keeping with current guidelines. In particular, transthoracic needle aspiration (TTNA) was suggested in 26% of patients despite advanced stage disease. Conclusion. Guideline-concordant recommendations for investigation of suspected lung cancer are rarely available on CT reports. This is true with respect to both imaging studies and invasive diagnostic procedures. Incorporation of more evidence-based suggestions may reduce quality gaps in lung cancer diagnosis and staging.

show abstract

Impact of rapid investigation clinic on timeliness of lung cancer diagnosis and treatment

Cited by 15 publications

References 26 publications

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

Predicting delays in lung cancer diagnosis and staging

An Audit of CT Chest Reports and Their Potential Impact on the Workup of Patients with Suspected Lung Cancer

Contact Info

Product

Resources

About