Audit of referral pathways in the diagnosis of lung cancer: a pilot study
Geraldine Largey A C , Samantha Chakraborty B , Tracey Tobias A , Peter Briggs A and Danielle Mazza B
+ Author Affiliations
- Author Affiliations
A Southern Melbourne Integrated Cancer Service, PO Box 73, 823–865 Centre Road, East Bentleigh, Vic. 3165, Australia.
B Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
C Corresponding author. Email: Geraldine.Largey@southernhealth.org.au
Australian Journal of Primary Health 21(1) 106-110 https://doi.org/10.1071/PY13043
Submitted: 20 March 2013 Accepted: 23 August 2013 Published: 18 October 2013
Abstract
This pilot study sought to describe the diagnostic pathways for patients with lung cancer and explore the feasibility of a medical record audit for this purpose. An audit of 25 medical records of patients with a confirmed diagnosis of lung cancer was conducted, at a single outer metropolitan hospital in Victoria. Patients were presented to secondary care from general practice (n = 17, 68%), the emergency department (n = 3, 12%) or specialist rooms (n = 1, 4%). Those who journeyed through general practice experienced the longest median intervals to diagnosis (20 days, interquartile range 7–47). The majority of patients (n = 15, 60%) were referred by a specialist to a multidisciplinary team after a diagnosis had been confirmed but before treatment commenced. These patients waited a median of 20 days from their first specialist appointment to a multidisciplinary team appointment. This research illustrated that a variety of pathways to diagnosis exist. Critically, it requires patient data and additional auditing of primary, public and private health sector records to determine generalisability of findings and the effectiveness of a medical record audit as a data collection tool.
Additional keywords: cancer, care pathways, diagnostic intervals, multidisciplinary.
References
Allgar VL, Neal RD (2005) Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer. British Journal of Cancer 92, 1959–1970.| Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M3ot1KjtQ%3D%3D&md5=7771a5a92090e6bec1ae6e15bec712b5CAS | 15870714PubMed |
Australian Institute of Health and Welfare, Australasian Association of Cancer Registries (2010) Cancer in Australia: an overview. Cancer series no. 60. Cat. no. CAN 56. AIHW, Canberra.
Australian Institute of Health and Welfare, Cancer Australia (2011) Lung cancer in Australia: an overview. Cancer series no. 64. AIHW, Canberra.
Australian Institute of Health and Welfare, Australasian Association of Cancer Registries, National Cancer Strategies Group, McDermid I (2005) ‘Cancer incidence projections, Australia 2002 to 2011.’ (Australian Institute of Health and Welfare, Australasian Association of Cancer Registries and the National Cancer Strategies Group: Canberra)
Banks NJ (1998) Designing medical record abstraction forms. International Journal for Quality in Health Care 10, 163–167.
| Designing medical record abstraction forms.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1czltlajsg%3D%3D&md5=9ac191da7bda1bf74914be520eb9743bCAS | 9690890PubMed |
Barrett J, Hamilton W (2008) Pathways to the diagnosis of lung cancer in the UK: a cohort study. BMC Family Practice 9, 31
| Pathways to the diagnosis of lung cancer in the UK: a cohort study.Crossref | GoogleScholarGoogle Scholar | 18485242PubMed |
Baughan P, O’Neill B, Fletcher E (2009) Auditing the diagnosis of cancer in primary care: the experience in Scotland. The British Journal of Cancer 101, S87–S91.
| Auditing the diagnosis of cancer in primary care: the experience in Scotland.Crossref | GoogleScholarGoogle Scholar |
Bjerager M, Palshof T, Dahl R, Vedsted P, Olesen F (2006) Delay in diagnosis of lung cancer in general practice. The British Journal of General Practice 56, 863–868.
Brindle L, Pope C, Corner J, Leydon G, Banerjee A (2012) Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study. BMJ Open 2, e001977
| Eliciting symptoms interpreted as normal by patients with early-stage lung cancer: could GP elicitation of normalised symptoms reduce delay in diagnosis? Cross-sectional interview study.Crossref | GoogleScholarGoogle Scholar | 23166137PubMed |
Brocken P, Kiers BA, Looijen-Salamon MG, Dekhuijzen PN, Smits-van der Graaf C, Peters-Bax L, de Geus-Oei LF, van der Heijden HF (2012) Timeliness of lung cancer diagnosis and treatment in a rapid outpatient diagnostic program with combined (18)FDG-PET and contrast enhanced CT scanning. Lung Cancer (Amsterdam, Netherlands) 75, 336–341.
| Timeliness of lung cancer diagnosis and treatment in a rapid outpatient diagnostic program with combined (18)FDG-PET and contrast enhanced CT scanning.Crossref | GoogleScholarGoogle Scholar |
Cancer Australia (2012) ‘Investigating symptoms of lung cancer: a guide for general practitioners.’ (Cancer Australia: Sydney)
Cassidy LD, Marsh GM, Holleran MK, Ruhl LS (2002) Methodology to improve data quality from chart review in the managed care setting. The American Journal of Managed Care 8, 787–793.
Conron M, Phuah S, Steinfort D, Dabscheck E, Wright G, Hart D (2007) Analysis of multidisciplinary lung cancer practice. Internal Medicine Journal 37, 18–25.
| Analysis of multidisciplinary lung cancer practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s%2FgsVekug%3D%3D&md5=268d24ed5726fe6f1709f90683ecefcaCAS | 17199840PubMed |
Coory M, Gkolia P, Yang IA, Bowman RV, Fong KM (2008) Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer (Amsterdam, Netherlands) 60, 14–21.
| Systematic review of multidisciplinary teams in the management of lung cancer.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1c3itFKkug%3D%3D&md5=713c5915589e78f8b880ef6c359a55edCAS |
Corner J, Hopkinson J, Fitzsimmons D, Barclay S, Muers M (2005) Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollections of symptoms before diagnosis. Thorax 60, 314–319.
| Is late diagnosis of lung cancer inevitable? Interview study of patients’ recollections of symptoms before diagnosis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2M7lvVOmtQ%3D%3D&md5=09ce1e4ae56a0cb8ebefc2bb29937f29CAS | 15790987PubMed |
Ellis PM, Vandermeer R (2011) Delays in the diagnosis of lung cancer. Journal of Thoracic Disease 3, 183–188.
Hansen RP, Vedsted P, Sokolowski I, Sondergaard J, Olesen F (2011) Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients. BMC Health Services Research 11, 284
| Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients.Crossref | GoogleScholarGoogle Scholar | 22027084PubMed |
Lamb BW, Brown KF, Nagpal K, Vincent C, Green JS, Sevdalis N (2011) Quality of care management decisions by multidisciplinary cancer teams: a systematic review. Annals of Surgical Oncology 18, 2116–2125.
| Quality of care management decisions by multidisciplinary cancer teams: a systematic review.Crossref | GoogleScholarGoogle Scholar | 21442345PubMed |
Lim WS, Macfarlane JT, Deegan PC, Manhire A, Holmes WF, Baldwin DR (1999) How do general practitioners respond to reports of abnormal chest X-rays? Journal of the Royal Society of Medicine 92, 446–449.
Lo DS, Zeldin RA, Skrastins R, Fraser IM, Newman H, Monavvari A, Ung YC, Joseph H, Downton T, Maxwell L, Meharchand J (2007) Time to treat: a system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis. Journal of Thoracic Oncology 2, 1001–1006.
| Time to treat: a system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis.Crossref | GoogleScholarGoogle Scholar | 17975490PubMed |
Metropolitan Health and Aged Care Services Division (2006) ‘Patient management framework: lung tumour stream: non-small cell lung cancer, a guide to cancer care.’ (Victorian Government Department of Human Services: Melbourne)
Murray MD, Smith FE, Fox J, Teal EY, Kesterson JG, Stiffler T, Ambuehl RJ, Wang J, Dibble M, Benge DO, Betley LJ, Tierney WM, McDonald CJ (2003) Structure, functions, and activities of a research support informatics section. Journal of the American Medical Informatics Association 10, 389–398.
| Structure, functions, and activities of a research support informatics section.Crossref | GoogleScholarGoogle Scholar | 12668695PubMed |
National Collaborating Centre for Cancer (2011) ‘The diagnosis and treatment of lung cancer (update).’ (National Collaborating Centre for Cancer: Wales)
Nielsen TN, Hansen RP, Vedsted P (2010) Symptom presentation in cancer patients in general practice. Ugeskrift for Laeger 172, 2827–2831.
Patkar V, Acosta D, Davidson T, Jones A, Fox J, Keshtgar M (2011) Cancer multidisciplinary team meetings: evidence, challenges, and the role of clinical decision support technology. International Journal of Breast Cancer 2011, 831 605
| Cancer multidisciplinary team meetings: evidence, challenges, and the role of clinical decision support technology.Crossref | GoogleScholarGoogle Scholar |
Salomaa ER, Sallinen S, Hiekkanen H, Liippo K (2005) Delays in the diagnosis and treatment of lung cancer. Chest 128, 2282–2288.
| Delays in the diagnosis and treatment of lung cancer.Crossref | GoogleScholarGoogle Scholar | 16236885PubMed |
The Collaboration for Cancer Outcomes Research and Evaluation (2003) ‘A cancer services framework for Victoria.’ (The Collaboration for Cancer Outcomes Research and Evaluation: Melbourne)
Valdés S, Garcia E, Perez H, Hernandez M (2010) Length of diagnostic delay in patients with non-small-cell lung cancer. MEDICC Review 12, 29–32.
Vedsted P, Olesen F (2011) Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic study. The British Journal of General Practice 61, e508–e512.
| Are the serious problems in cancer survival partly rooted in gatekeeper principles? An ecologic study.Crossref | GoogleScholarGoogle Scholar | 21801563PubMed |
Walter F, Webster A, Scott S, Emery J (2012) The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. Journal of Health Services Research & Policy 17, 110–118.
| The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis.Crossref | GoogleScholarGoogle Scholar |
Wang T, Nelson RA, Bogardus A, Grannis FWJ (2010) Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival? Cancer 116, 1518–1525.
| Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival?Crossref | GoogleScholarGoogle Scholar | 20108308PubMed |
Weller D, Vedsted P, Rubin G, Walter FM, Emery J, Scott S, Campbell C, Andersen RS, Hamilton W, Olesen F, Rose P, Nafees S, Rijswijk E, Hiom S, Muth C, Beyer M, Neal RD (2012) The Aarhus statement: improving design and reporting of studies on early cancer diagnosis. British Journal of Cancer 106, 1262–1267.
| The Aarhus statement: improving design and reporting of studies on early cancer diagnosis.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38vms1Gjtw%3D%3D&md5=7b23adaa62f85205af5b21e0bead3bb0CAS | 22415239PubMed |
