Integrating Regional and Community Lung Cancer Services to Improve Patient Care

Dahele, Max; Ung, Yee C.; Meharchand, J.; Shulman, Harry; Zeldin, Robert A.; Behzadi, Abdollah; Simone, Carmine; Cheng, Susanna; Weigensberg, Corey; Sivjee, Khalil

doi:10.3747/co.2007.157

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…With regard to access to treatment, the comments in the consultation are consistent with data indicating that in some instances, there is less than optimal access to treatment, and that reorganization of the health care system can afford benefits [27][28][29]. Consistent with this, a series of studies undertaken in NSW describes less than optimal use of radiotherapy, with the optimal utilization rate being between 45% and 68% at initial diagnosis [30].…”

Section: Provider Factorssupporting

confidence: 56%

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

Jiwa¹,

Davidson²,

Newton³

et al. 2012

JCT

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Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two-phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualitative thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was considered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people under-report morbidity related to smoking and chronic obstructive pulmonary disease; other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes

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Section: Provider Factorssupporting

confidence: 56%

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

Jiwa¹,

Davidson²,

Newton³

et al. 2012

JCT

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“…Ongoing follow-up care by family physician 7 Results go to ordering and referring physician and family physician 8 For more information about biomarkers, refer to the Lung Cancer Tissue Pathway 9 Follow-up as per the Fleischner guidelines. For more information see Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans : A Statement from the Fleischner Society.…”

Section: Negative For Cancermentioning

confidence: 99%

“…Such delays may be due to prolonged diagnostic work up preceding and following specialist referral (7). I n r e s p o n s e t o t h e n e e d f o r a n e f f i c i e n t a n d multidisciplinary approach to the assessment of patients with suspected lung cancer, tertiary health institutions within Ontario have established streamlined diagnostic assessment pathways (8,9). One such program was effective in reducing the time from initial suspicion of lung cancer to a diagnosis being made (8).…”

Section: Introductionmentioning

confidence: 99%

The impact of concordance with a lung cancer diagnosis pathway guideline on treatment access in patients with stage IV lung cancer

Pattison¹,

Jeagal²,

Yasufuku³

et al. 2020

J Thorac Dis

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Background: Timely access to treatment of lung cancer is dependent on efficient and appropriate patient assessment and early referral for diagnostic workup. This study assesses the impact of Cancer Care Ontario (CCO) Lung Cancer Diagnostic Pathway Guideline (LCDPG) concordance on access to treatment of stage IV lung cancer patients referred to the Diagnostic Assessment Program (DAP) at a Canadian tertiary cancer centre. Methods: This retrospective cohort study includes patients diagnosed with clinical stage IV lung cancer referred to the DAP at a Canadian tertiary cancer centre between November 1, 2015 and May 31, 2017.Referral concordance was determined based on CCO LCDPG. The primary outcome; time to treatment from initial healthcare presentation; was compared between the concordant and discordant referrals. Results: Two hundred patients were referred for clinical stage IV lung cancer during the study period. Of these referrals, 151 (75.5%) were assessed and referred in concordance with LCDPG. Guideline concordant referrals were associated with reduced time to treatment from first healthcare presentation compared with guideline discordant referrals (55.3 vs. 108.8 days, P<0.001). Time to diagnostic procedure (32.2 vs. 86.7 days, P<0.001) and decision to treat (38.5 vs. 93.8 days, P<0.001) were also reduced with guideline concordance.The most common reason for discordant assessment and referral was delayed or inadequate investigation of symptoms in a high risk patient (32.7% of discordant referrals). Conclusions: Guideline concordant assessment and referral of stage IV lung cancer patients results in reduced time to diagnosis and treatment. Future research and education should focus on improving factors that delay DAP referral.

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“…Studies have confirmed the tight link between objective performance status assessment and patient-reported quality of life. 12,13 Data were extracted in de-identified aggregate from the Carolinas Consortium Palliative Care Database, reflecting patient encounters between June 1, 2008 and December 31, 2011. To ensure that results reflected community-based nonacademic palliative care, any records from Duke University Health System were excluded.…”

Section: Taylor Et Almentioning

confidence: 99%

The Effect of Palliative Care on Patient Functioning

Taylor

Bull

Zhong

et al. 2013

Journal of Palliative Medicine

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Background: Palliative care is increasingly viewed as a care option that should not only be offered to patients very near the end of life. An important question is whether increased use of palliative care soon after a patient's referral will improve patient functioning, an aspect of quality of life. Objectives: The aim of this study was to determine if increased use of palliative care is associated with increased patient functioning. Methods: The Carolinas Palliative Care Database Consortium collects palliative care encounter data from a variety of providers, settings, and patients, and it measures patient functioning, allowing us to test the hypothesis that increased use of palliative care early in a patient's palliative care experience will improve patient functioning. Results: After controlling for other factors that could explain patient functioning, we find that each additional palliative care visit during the first month of follow-up increases patient functioning measured using an area under the curve (AUC) approach (0.008 per visit, p = 0.01). However, patient functioning as measured at the initial visit is a far stronger predictor of subsequent functioning (0.52, p < 0.001) than are additional palliative care visits. Conclusions: Increased use of palliative care was associated with improved patient functioning. This held true at very low as well as very high levels of initial functioning. The strongest predictor of subsequent patient functioning is their initial status. Accounting for patient-specific differences to precisely determine the impact of palliative care on patient functioning is difficult.

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Integrating Regional and Community Lung Cancer Services to Improve Patient Care

Cited by 5 publications

References 3 publications

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia

The impact of concordance with a lung cancer diagnosis pathway guideline on treatment access in patients with stage IV lung cancer

The Effect of Palliative Care on Patient Functioning

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