Introduction
This mixed methods study compares lung cancer diagnostic and treatment intervals with agreed target measures across three public health services in Victoria and provides an in-depth understanding of the barriers clinicians face in their respective practice settings, to the timely diagnosis of patients with lung cancer.
Methods
A retrospective medical record audit of 98 patients with a new diagnosis of lung cancer was conducted. Three specific referral interval timings were looked at. The interval from referral to diagnosis, diagnosis to first treatment and referral to first treatment were measured. The referral to first treatment interval was further compared according to treatment type received (surgery, radiotherapy or chemotherapy). This was followed by 19 semi structured interviews with expert members of lung multidisciplinary teams (MDTs). Expert participants included cardiothoracic surgeons (n=2), medical oncologists (n=5), respiratory physicians (n=5), registered nurses (n=4), radiation oncologists (n=2] and radiologist (n=1).
Results
A number of the records audited had insufficient pathway detail recorded to measure the required intervals. Approximately 70% of patients [n=74] across the region, had a diagnosis of new lung cancer confirmed within the referral to diagnosis interval target of ≤ 28 days. A modest 50% of patients [n=81] achieved our diagnosis to first treatment interval of ≤ 14 days. Indeed 29 of 81 cases waited longer than 30 days from diagnosis to first treatment. Only 31% [n=6/19] of surgical, 42% [n=8/19] of chemotherapy and 55% [n=11/20] of radiotherapy patients achieved the referral to first treatment target of ≤ 42 days.