Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program

Common, Jessica; Mariathas, Hensley H.; Parsons, Kaylah; Greenland, Jonathan; Harris, Scott R.; Bhatia, Rick; Byrne, Suzanne C.

doi:10.1016/j.carj.2018.02.001

Cited by 20 publications

(24 citation statements)

References 12 publications

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“…This allows for a provider to review the patient's information and approve an official scheduled consult. In coordination with a streamlined referral process as seen with the international patients, this has been shown to be effective at minimizing time between diagnosis and treatment, suggesting that a rigorous intake process is critical for proton centers to reduce delays that may adversely affect patient outcomes, including those of children [42]. Based on the results of our study, pediatric PBT patients living .…”

Section: Variablementioning

confidence: 86%

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

Liu

Brooks

Rubin

et al. 2020

International Journal of Particle Therapy

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Purpose Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center. Patients and Methods Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death. Results 96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; P = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; P = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; P = .43). Conclusion We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.

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Section: Variablementioning

confidence: 86%

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

Liu

Brooks

Rubin

et al. 2020

International Journal of Particle Therapy

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“…Previous studies have demonstrated the beneficial effects of triage systems on lead times in various oncological and elective care pathways. 21 , 22 , 26–29 Common et al implemented a Thoracic Triage Panel to expedite lung cancer diagnosis and treatment initiation. 21 They reported a reduction in median lead time from first abnormal imaging to biopsy from 61.5 to 36 days and to treatment initiation from 118.0 to 80.0 days.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 22 , 26–29 Common et al implemented a Thoracic Triage Panel to expedite lung cancer diagnosis and treatment initiation. 21 They reported a reduction in median lead time from first abnormal imaging to biopsy from 61.5 to 36 days and to treatment initiation from 118.0 to 80.0 days. Patterson et al realized an e-mail triage panel to optimize general practitioner referrals to the neurologist.…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor

Swart

Kouwenhoven

Hellingman

et al. 2021

Neuro-Oncology Practice

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Background Regional collaboration and appropriate referral management are crucial in neuro-oncological care. Lack of electronic access to medical records across healthcare organisations impedes interhospital consultation and may lead to incomplete and delayed referrals. To improve referral management, we have established a multidisciplinary Neuro-Oncological Triage Panel (NOTP) with digital image exchange and determined the effects on lead times, costs and time investment. Methods A prospective cohort study was conducted from February 2019 to March 2020. All newly diagnosed patients referred to Brain Tumor Center Amsterdam were analyzed according referral pathway: 1) standard referral, 2) NOTP. The primary outcome was lead time, defined as time-to-referral, time-to-treatment, and total time (median days [interquartile range]). Secondary outcomes were costs and time investment. Results In total, 225 patients were included, of whom 153 had standard referral and 72 NOTP referral. Patients discussed in the NOTP were referred more frequently for first neurosurgical consultation (44.7% versus 28.8%) or combined neurological and neurosurgical consultation (12.8% versus 2.5%, p=0.002). Time-to-referral was reduced for NOTP referral compared to standard referral (1[0.25-4] versus 6[1.5-10] days, p<0.001). Total time decreased from 27[14-48] days for the standard group to 15[12-38.25] days for the NOTP group (p=0.040). Costs and time investment were comparable for both groups. Conclusion Implementation of digital referral to a multidisciplinary NOTP is feasible and leads to more swift patient-tailored referrals at comparable costs and time investment as standard referral. This quality improvement initiative has the potential to improve collaboration and coordination of multidisciplinary care in the field of neuro-oncology.

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“…Nevertheless, many centres in North America and Europe have successfully used interventions such as care navigators and rapid diagnostic assessment programs to improve wait times for patients with lung cancer. However, the wait time most commonly reported and targeted is the time from lung cancer diagnosis to initial treatment 4 , and studies that address delays specifically in the diagnostic phase of care are fewer 2,6,7 . Given that the diagnostic phase of care can be an extremely distressing period for patients suspected of having lung cancer 8 and that arriving at a diagnosis more quickly can reduce patient anxiety 9 , shortening any diagnostic delays is favourable.…”

Section: Discussionmentioning

confidence: 99%

Implementing A One-Day Testing Model Improves Timeliness of Workup for Patients with Lung Cancer

et al. 2019

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Background Patients with lung cancer often experience stressful delays throughout the diagnostic phase of care. To address that situation, our multidisciplinary team created a “Navigation Day,” during which patients partake in a single-day visit that comprises nurse-led teaching, social work, smoking cessation counselling, symptom control, and dedicated test slots for integrated positron-emission tomography and computed tomography (pet/ct), pulmonary function tests (pfts), and magnetic resonance imaging (mri) of the brain. We evaluated the effects of that program on wait times and patient satisfaction.Methods Patients with a suspicion of lung cancer on chest ct imaging referred during 3 time periods were reviewed: 1 year before launch of the Navigation Day, 1 year post-launch, and 2 years post-launch. Patients were further stratified according to concordance of their test date with a Navigation Day date. Mean wait times for pet/ct, pfts, and mri brain were calculated for each group. Patient satisfaction was measured using a standardized provincial survey. The Student t-test and analysis of variance were used to assess for significance.Results After implementation, mean wait times in the first year improved to 9.2 days from 15.5 days for pet/ct (p < 0.0001), to 9.6 days from 15.7 days for pfts (p < 0.0001), and to 10.2 days from 16.0 days for mri brain (p < 0.0001). Patients who used a dedicated test slot experienced the shortest wait times, at 5.8 days for pet/ct, 5.8 days for pfts, and 6.3 days for mri brain (p < 0.0001). Those improvements were sustained at 2 years post-launch. Patient satisfaction in the categories of assistance, emotional support, and clarity remained high post-launch.Conclusions Navigation Day significantly improved the timeliness of diagnostic testing services in patients with suspected lung cancer.

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Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program

Abstract: A collaborative, centralized intake and referral program helps to reduce wait time for diagnosis and treatment of lung cancer.

Cited by 20 publications

References 12 publications

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

A multidisciplinary neuro-oncological triage panel reduces the time to referral and treatment for patients with a brain tumor

Implementing A One-Day Testing Model Improves Timeliness of Workup for Patients with Lung Cancer

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