Referring patients to a panel of thoracic experts immediately after initial diagnostic workup reduces wait times for the diagnosis and treatment of lung cancer, according to research out of the Health Sciences Centre in St. John’s, Newfoundland, Canada.
Timely diagnosis and treatment is critical for survival in most cancer cases, lead author Jessica L. Common, BSc, and co-authors wrote in the current edition of the Canadian Association of Radiologists Journal, but lung cancer progresses especially quickly, with survival rates dropping from 49 percent in stage IA to 1 percent in stage IV.
“The pathway for diagnosis of a suspected lung cancer is complex, and wait times for individual diagnostic procedures and specialist appointments can be lengthy,” Common et al. wrote. “Minimizing wait times reduces patients’ emotional distress as well as healthcare costs incurred in the workup period.”
In the past, the authors said their practice had tried hiring additional CT techs and extending operating hours for computed tomography—but, though both methods reduced wait times somewhat, they were still prolonged by inefficiencies in the system and inappropriate specialist referrals.
In 2014, the researchers wrote, the institution instead turned to a Thoracic Triage Panel (TTP), which was a centralized referral program created to streamline workflow and speed up wait times for patients. The TTP stressed regular communication with primary care providers, which was facilitated by nurse navigation and weekly meetings with a working group of radiology, respirology, medical and radiation oncology, thoracic surgery and pathology specialists.
Nurses acted as liaisons in the TTP, Common and colleagues said, coordinating communication between experts, primary care providers and patients themselves. One year after the TTP was launched, the hospital began a yearlong study to assess its efficacy.
A total of 133 patients with a diagnosis of lung cancer and initial diagnostic imaging were included in the study, the authors wrote. Seventy-nine were referred to the TTP, while 54 were managed traditionally.
Wait times from the first abnormal imaging study to treatment initiation in the TTP cohort dropped from 118 to 80 days, and wait time from first abnormal imaging to biopsy plummeted from 61.5 to 36 days, the researchers reported.
“In our program, patients are discussed at weekly, multidisciplinary meetings and the appropriate investigations and the specialist referrals are arranged before the patients meet face-to-face with a specialist,” Common and colleagues said. “Unlike traditional tumor boards that meet to discuss treatment options following diagnosis, our panel discusses patients with radiological suspicion of lung cancer and, in most cases, very little additional diagnostic workup.”
The authors said the results of the study are promising, but more research is needed to discover if reduced wait times translate to better patient outcomes.
“Once validated, our multidisciplinary, centralized referral model may be adopted by other institutions across the country as an adjunct to primary and secondary prevention strategies aimed at reducing the burden of lung cancer in Canada,” they wrote.