Optimal lung cancer care pathways: a Tasmanian perspective
Chui Lyn Leong
A * , Ingrid Cox B , Renae Grundy A , Nick Harkness A , Andrew J. Palmer B , Barbara de Graaff B and Emma Ball A
A
B
Abstract
In Australia, Tasmania has the second highest rate of incident lung cancer cases at 44.0 per 100,000 population, with an overall 5 year relative survival rate of 20%. The aim of this retrospective study was to map and compare patient transit timelines from referral, diagnosis and treatment, to national care quality indicators (NCQI) and optimal care pathway (OCP) benchmarks.
Data were extracted from the weekly lung cancer multidisciplinary team meeting minutes, digital medical records and the ARIA Oncology-Information System for newly diagnosed small cell and non-small cell lung cancer cases between 2019 and 2022, at a regional, university-affiliated tertiary hospital in Tasmania. Sociodemographic data and key dates were extracted, including first general practitioner (GP) referral, specialist appointments (respiratory, medical oncology, radiation oncology and cardiothoracic), investigations, diagnosis, staging and treatment of any intent. Timelines were benchmarked against NCQI and the OCP.
A total of 165 cases were included; mean patient age was 72 years, and 57% were male. A total of 153 patients (93%) were diagnosed with non-small cell cancer and 12 (7%) with small cell lung cancer. Results for all years showed that 93% of patients were seen by the respiratory service within 14 days of their GP referral and 71% diagnosed within 28 days of their referral, in accordance with current standards. The time taken between GP referrals and diagnosis to any treatment was greater than the required standards, with on average 7% of patients meeting the quality standards (range, 0–16%) for all treatment intents.
Current national benchmarks have proven challenging to achieve, with prolonged time to treatment of any intent. Challenges both at a patient and systemic level will need to be assessed to improve clinical indicator outcomes.
Keywords: lung cancer, national care quality indicator, non small cell lung cancer, optimal care pathway benchmark, screening program, small cell, timeliness in care.
References
2 Australian Institute of Health and Welfare. Cancer data in Australia. State and Territory Supplementary Tables. Canberra: Australian Institute of Health and Welfare; 2024. Available at https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia [cited 7 September 2024].
4 Otahal P, Roydhouse J, Ragaini BS, Venn A. Cancer survival and prevalence in Tasmania 1978-2017. Menzies Institute for Medical Research University of Tasmania; 2021. Available at https://www.menzies.utas.edu.au/__data/assets/pdf_file/0010/1457767/Survival_Report_1978-2017.pdf
5 Australian Institute of Health and Welfare. Cancer in Australia 2017. Australian Institute of Health and Welfare; 2017. Available at https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/summary [cited 7 September 2024].
6 Janssen-Heijnen MLG, Coebergh JWW. Trends in incidence and prognosis of the histological subtypes of lung cancer in North America, Australia, New Zealand and Europe. Lung Cancer 2001; 31(2): 123-37.
| Crossref | Google Scholar |
9 Lung Cancer Clinical Quality Data Platform. Improving Lung Cancer Care in Australia. 2022. Available at https://lucap-au.com/ [cited 7 September 2024].
11 Australian Bureau of Statistics. Socio-Economic Indexes for Areas. Australian Bureau of Statistics; 2020. Available athttps://www.abs.gov.au/statistics/people/people-and-communities/socio-economic-indexes-areas-seifa-australia/latest-release
12 Largey G, Ristevski E, Chambers H, Davis H, Briggs P. Lung cancer interval times from point of referral to the acute health sector to the start of first treatment. Aust Health Rev 2016; 40(6): 649-654.
| Crossref | Google Scholar | PubMed |
13 Malalasekera A, Blinman PL, Dhillon HM, et al. Times to Diagnosis and Treatment of Lung Cancer in New South Wales, Australia: A Multicenter, Medicare Data Linkage Study. J Oncol Pract 2018; 14(10): e621-e630.
| Crossref | Google Scholar | PubMed |
14 Vinod SK, Chandra A, Berthelsen A, Descallar J. Does timeliness of care in non-small cell lung cancer impact on survival? Lung Cancer 2017; 112: 16-24.
| Crossref | Google Scholar | PubMed |
15 Australian Institute for Health and Welfare. Australia’s hospitals at a glance: Access to hospitals. Australian Institute of Health and Welfare; 2022. Available at https://www.aihw.gov.au/reports/hospitals/australias-hospitals-at-a-glance
16 Kale MS, Mhango G, Gomez JE, Sigel K, Smith CB, Bonomi M, et al. Treatment Toxicity in Elderly Patients With Advanced Non-Small Cell Lung Cancer. Am J Clin Oncol 2017; 40(5): 470-476.
| Crossref | Google Scholar | PubMed |
17 Kim J, Hurria A. Determining chemotherapy tolerance in older patients with cancer. J Natl Compr Canc Netw 2013; 11(12): 1494-502.
| Crossref | Google Scholar | PubMed |
18 Pham J, Conron M, Wright G, Mitchell P, Ball D, Philip J, et al. Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era? ERJ Open Res 2021; 7(2): 00393-2020.
| Crossref | Google Scholar | PubMed |
19 Bensken WP, Schiltz NK, Warner DF, Kim DH, Wei MY, Quiñones AR, et al. Comparing the association between multiple chronic conditions, multimorbidity, frailty, and survival among older patients with cancer. J Geriatr Oncol. 2022; 13(8): 1244-1252.
| Crossref | Google Scholar | PubMed |
20 Niksic M, Redondo-Sanchez D, Chang YL, Rodriguez-Barranco M, Exposito-Hernandez J, Marcos-Gragera R, et al. The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study. BMC Cancer 2021; 21(1): 1048.
| Crossref | Google Scholar | PubMed |
21 Franchi M, Rea F, Santucci C, La Vecchia C, Boffetta P, Corrao G. Developing a multimorbidity prognostic score in elderly patients with solid cancer using administrative databases from Italy. Aging Cancer 2021; 2(3): 98-104.
| Crossref | Google Scholar |
22 Geiger GA, Kim MB, Xanthopoulos EP, Pryma DA, Grover S, Plastaras JP, et al. Stage migration in planning PET/CT scans in patients due to receive radiotherapy for non-small-cell lung cancer. Clin Lung Cancer 2014; 15(1): 79-85.
| Crossref | Google Scholar | PubMed |
23 Ponholzer F, Kroepfl V, Ng C, Maier H, Kocher F, Lucciarini P, et al. Delay to surgical treatment in lung cancer patients and its impact on survival in a video-assisted thoracoscopic lobectomy cohort. Sci Rep 2021; 11(1): 4914.
| Crossref | Google Scholar | PubMed |
24 Wu CF, Chao YK. Saving time is saving lives: a delayed lobectomy predicts poorer overall survival in patients with clinical stage IA squamous cell carcinoma of the lung. J Thorac Dis 2018; 10(26): S3147-S3148.
| Crossref | Google Scholar | PubMed |
25 Heiden BT, Eaton DB, Engelhardt KE, Chang SH, Yan Y, Patel MR, et al. Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer. JAMA Netw Open 2021; 4(5): e2111613.
| Crossref | Google Scholar |
26 Singh S, Sridhar P. A narrative review of sociodemographic risk and disparities in screening, diagnosis, treatment, and outcomes of the most common extrathoracic malignancies in the United States. J Thorac Dis 2021; 13(6): 3827-3843.
| Crossref | Google Scholar | PubMed |
27 National Lung Cancer Screening Program. Australian Government Department of Health; 2022. Available at http://msac.gov.au/internet/msac/publishing.nsf/content/1699-public
28 Chua A, Nguyen E, Puah LL, Soong J, Keesing S. Experiences of People with Cancer from Rural and Remote Areas of Western Australia Using Supported Accommodation in Perth While Undergoing Treatment. Curr Oncol 2022; 29(2): 1190-1200.
| Crossref | Google Scholar | PubMed |
29 Hall SE, Holman CD, Threlfall T, Sheiner H, Phillips M, Katriss P, et al. Lung cancer: an exploration of patient and general practitioner perspectives on the realities of care in rural Western Australia. Aust J Rural Health 2008; 16(6): 355-362.
| Crossref | Google Scholar | PubMed |
30 Cancer in Rural Australia. Cancer in Rural Australia – Fact sheet July 2022. National Rural Health Alliance; 2022. Available at https://www.ruralhealth.org.au/sites/default/files/publications/nrha-cancer-factsheet-july2022.pdf
31 Queensland Report of the Chief Health Officer. Cancer Incidence. Report of the Chief Health Officer Queensland. 2023. Available at https://www.choreport.health.qld.gov.au/our-health/cancer/cancer-incidence
