Reduced delays in diagnostic pathways for non-small cell lung cancer after local and National initiatives

Dan Laerum; Odd Terje Brustugun; Frode Gallefoss; Ragnhild Falk; Trond-Erik Strand; Lars Fjellbirkeland

doi:10.1016/j.ctarc.2020.100168

Reduced delays in diagnostic pathways for non-small cell lung cancer after local and National initiatives

Cancer Treat Res Commun. 2020 Jan 22:23:100168. doi: 10.1016/j.ctarc.2020.100168. Online ahead of print.

Authors

Dan Laerum¹, Odd Terje Brustugun², Frode Gallefoss³, Ragnhild Falk⁴, Trond-Erik Strand⁵, Lars Fjellbirkeland⁶

Affiliations

¹ Department of Internal Medicine, Pulmonary Section, Sorlandet Hospital Kristiansand, Kristiansand, Norway. Electronic address: dan.larum@sshf.no.
² Section of Oncology, Drammen Hospital - Vestre Viken Hospital Trust, Drammen, Norway.
³ Department of Research, Sorlandet Hospital Kristiansand, Kristiansand/Norway and Medical Faculty, University of Bergen, Bergen, Norway.
⁴ Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
⁵ Cancer Registry of Norway, Oslo, Norway.
⁶ Department of Respiratory Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.

PMID: 32028190
DOI: 10.1016/j.ctarc.2020.100168

Abstract

Objectives: Patients with non-small cell lung cancer (NSCLC) may experience progression and stage shift due to delays in a complex and time-consuming diagnostic work-up. We have analyzed the impact of both a local and national intervention on total time to treatment (TTT).

Material and methods: All patients diagnosed with NSCLC at a Norwegian county hospital from 2007 to 2016 were reviewed. Logistic bottlenecks and delays were identified (2007-12) resulting in implementation of a local initiative with new diagnostic algorithm introduced by the beginning of 2013. In 2015, national diagnostic cancer pathways were implemented. TTT defined as time from received referral from the primary physician to start of treatment was compared in the three diagnostic time periods; baseline (2007-12), local (2013-14) and national (2015-16).

Results: A total of 780 patients were included. Among patients treated with curative intent the median TTT decreased by 21 days, from 64 to 43 days (p < 0.001) while the mean number of diagnostic procedures increased from 3.5 to 3.9. In median regression analysis, the local initiative was associated with a reduction of estimated 7.8 days (95% CI 3.2, 12.3) in TTT, while the national initiative correlated with a reduction of estimated 14.9 days (95% CI 10.2, 19.6) compared to time at baseline. Covariates associated with longer TTT were stage I, use of PET-CT, diagnostic procedure at external hospital, and number of diagnostic procedures.

Conclusion: Local and national initiatives significantly reduced TTT in NSCLC. The effect was most pronounced among patients with disease available for curative treatment.