Reasons for prolonged time for diagnostic workup for stage I-II lung cancer and estimated effect of applying an optimized pathway for diagnostic procedures

Abstract

Background:Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time forlung cancer is 42 days. The aim of this study was to identify reasons for delays and estimate the effect on thetimelines when applying an optimal diagnostic pathway.Methods:Retrospective review of medical records of lung cancer patients, with stage I-II at baseline CT, receivingcurative treatment (n= 100) at a regional cancer center in Norway.Results:Only 40% started treatment within 42 days. The most important delays were late referral to PET CT (n= 27)and exercise test (n= 16); repeated diagnostic procedures because bronchoscopy failed (n= 15); and need for furtherinvestigations after PET CT (n= 11). The time from referral to PET CT until the final report was 20.5 days in median.Applying current waiting time for PET CT (≤7 days), 48% would have started treatment within 42 days (p=0.254).“Optimal pathway”was defined as 1) referral to PET CT and exercise test immediately after the CT scan and hospitalvisit, 2) tumor board discussion to decide diagnostic strategy and treatment, 3) referral to surgery or curativeradiotherapy, 4) tissue sampling while waiting to start treatment. Applying the optimal pathway, current waiting timefor PET CT and observed waiting times for the other procedures, 80% of patients could have started treatment within42 days (p< 0.001), and the number of tissue sampling procedures could have been reduced from 112 to 92 (−16%).Conclusion:Changing the sequence of investigations would significantly reduce the time until start of treatment incurative lung cancer patients at our hospital and reduce the resources needed.