Lung cancer interval times from point of referral to the acute health sector to the start of first treatment

Largey, Geraldine; Ristevski, Eli; Chambers, Helen Phyllis; Davis, Heather; Briggs, Peter

doi:10.1071/ah15220

Cited by 11 publications

(15 citation statements)

References 15 publications

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“…Fatigue 75 (36) 79 (31) 64 (32) 61 (31) 38 (13) 55 (27) 92 (32) 60 2817 (19) 42 (20) 583 (27) <0.001…”

Section: Comparison With Other Studiesunclassified

“…Felt sick/vomiting/nausea/loss of appetite 42 (20) 33 (13) 31 (16) 24 (12) 33 1222 1145 (16) 28 133 320 (10) 281 (13) 0.132…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Other symptoms not listed above 51 (24) 80 (32) 59 (30) 54 (27) 63 2240 2030 (10) 75 3626 3042 (20) 520 (24) <0.001…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…No symptoms 29 (14) 24 (10) 32 (16) 21 (11) 63 (22) 50 (25) 67 2336 1733 (38) 75 (36) 430 (20) <0.001 45 (39) n/a 67 (44) 24 2818 (30) n/a 7 (41) 33 (41) 284 (39) 0.093 Breathlessness 17 (20) 27 (20) 20 (17) n/a 27 (18) 11 (13) 11 (18) n/a 4 2413 (16) 130 (18) 0.803 Non-specific symptom 11 (13) 23 (17) 19 (17) n/a 39 (26) 7 85 (8) n/a 5 (29) 13 (16) 122 (17) No symptoms/missing 12 (14) 13 (10) 17 (15) n/a 18 (12) 43 5018 (30) n/a 2 12) 20 (25) 143 (19) All figures are n (% Open access survival differences. 38 The rate of respondents who attended A&E varied twofold across jurisdictions from 9%-10% in England, Scotland and Denmark to 18%-20% in Northern Ireland, Ontario and Manitoba.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

et al. 2019

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ObjectiveDifferences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer.DesignNewly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity.ParticipantsConsecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS.Primary and secondary outcome measuresInterval lengths (days; primary), routes to diagnosis and symptoms (secondary).ResultsWith the exception of Denmark (−49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012–2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (−11 days) than Wales (20 days); Sweden had shorter (−20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (−13), Manitoba (−11), England (−9) and Northern Ireland (−4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%.ConclusionThere are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.

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“…Fatigue 75 (36) 79 (31) 64 (32) 61 (31) 38 (13) 55 (27) 92 (32) 60 2817 (19) 42 (20) 583 (27) <0.001…”

Section: Comparison With Other Studiesunclassified

“…Felt sick/vomiting/nausea/loss of appetite 42 (20) 33 (13) 31 (16) 24 (12) 33 1222 1145 (16) 28 133 320 (10) 281 (13) 0.132…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Other symptoms not listed above 51 (24) 80 (32) 59 (30) 54 (27) 63 2240 2030 (10) 75 3626 3042 (20) 520 (24) <0.001…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

et al. 2019

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“…Data for the case-note analysis will be collected using an audit tool with identifiable patient information removed. This audit tool is based on those previously used by the research team [ 21 , 22 ] and will collect data relevant to lung cancer diagnosis and treatment (e.g. date of diagnosis, date of GP referral) and patients’ demographic background (e.g.…”

Section: Methodsmentioning

confidence: 99%

The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds

et al. 2018

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BackgroundLung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences.MethodsThis is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted.DiscussionThis is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds.Trial registrationThe project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392, date registered: 4th July 2017).

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Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study

Purdie

Creighton

White

et al. 2019

npj Prim Care Resp Med

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Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.

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Lung cancer interval times from point of referral to the acute health sector to the start of first treatment

Cited by 11 publications

References 15 publications

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP)

The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds

Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study

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