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

Abstract

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.

Risk factors and prognostic implications of diagnosis of cancer within 30 days after an emergency hospital admission (emergency presentation): an International Cancer Benchmarking Partnership (ICBP) population-based study

“… 4 Other research indicates three major subtypes of emergency presenters: some have no history of primary care consultations, some have sought help and were being investigated electively when the emergency presentation occurred, and others have sought help (at times repeatedly) but no investigations were instigated ( appendix p 3 ). 24 , 25 Future international studies should address this gap by incorporating links to primary care electronic health records.…”

Lung, breast and bowel cancer treatment for Aboriginal people in New South Wales: a population‐based cohort study

“…One quarter of lung cancer diagnoses in NSW are via an emergency hospital admission 28 . Specialist consultations in an inpatient setting would not be captured in our study.…”

“…One quarter of lung cancer diagnoses in NSW are via an emergency hospital admission. 28 Specialist consultations in an inpatient setting would not be captured in our study. Emergency presentation has been linked to lower use of potentially curative surgery.…”

A Network-Guided Approach to Discover Phytochemical-Based Anticancer Therapy: Targeting MARK4 for Hepatocellular Carcinoma

“…Because of poor diagnosis and other circumstances, most cancer patients are detected too late to undergo surgery. As a result, there is a continuing desire for innovative, effective, and affordable anti-cancer medications (18)(19)(20). In many countries throughout the world, medicinal plants are used as a cancer therapy option (21)(22)(23).…”