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

• Published in: NPJ primary care respiratory medicine Vol. 29; no. 1; p. 2
• Main Authors: Purdie, Stuart, Creighton, Nicola, White, Kahren Maree, Baker, Deborah, Ewald, Dan, Lee, Chee Khoon, Lyon, Alison, Man, Johnathan, Michail, David, Miller, Alexis Andrew, Tan, Lawrence, Currow, David, Young, Jane M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 08-02-2019; Nature Publishing Group
• Subjects: 692/1807/1809; 692/308/174; 692/700/139; Cohort analysis; Family physicians; Health risk assessment; Internal Medicine; Lung cancer; Medical imaging; Medicine; Medicine & Public Health; Pneumology/Respiratory System; Primary Care Medicine; Surgeons; Thoracic Surgery; Australia
• ISSN: 2055-1010; 2055-1010
• DOI: 10.1038/s41533-018-0113-7

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.
Lung cancer: The pathways to diagnosis
Examining events leading to the diagnosis of non-small cell lung cancer (NSCLC) in Australia yields insights to guide further research and perhaps improve the pathways to diagnosis. NSCLC is by far the most common form of lung cancer. Researchers, led by the Cancer Institute New South Wales, investigated clinical care contacts leading to diagnosis, using a descriptive cohort study of 894 patients diagnosed between 2006 and 2012. The researchers quantified contact with GPs and lung specialists, hospital admissions and diagnostic imaging procedures. Living in remote locations had little influence on access to services. More than half of the patients did not see a lung specialist during the pathway to diagnosis, while a quarter received their diagnosis in an emergency setting. Further research should investigate whether there are barriers preventing timely diagnosis.