Improving Timeliness of Lung Cancer Diagnosis and Staging Investigations Through Implementation of Standardized Triage Pathways

Mullin, Monica; Tran, Audrey; Golemiec, Breanne; Stone, Christopher; Noseworthy, C.A.P.; O'Callaghan, Nicole; Parker, Christopher M.; Digby, Geneviève C.

doi:10.1200/jop.19.00807

Cited by 11 publications

(15 citation statements)

References 18 publications

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“…11 12 26 35 39 41 49 59 63 70 71 These articles were focused on varied cancer types (four each for multiple cancers, and one each for ear-nose-throat, urinary tract and gastrointestinal cancers). Three articles were from Denmark, 26 39 41 two from the UK 35 70 and one each from Canada, 59 Norway, 49 Sweden, 63 Spain 12 and Saudi Arabia. 11 The publications were on adult patient populations with one also involving paediatric patients.…”

Section: Standardised Care Pathwaysmentioning

confidence: 99%

“…The main effective pathways were the national diagnostic cancer pathway in Norway, with recommended maximum limits for time spent in the diagnostic process as well Open access as mandatory reporting of the actual time intervals for all patients with suspected lung cancer, 49 and the standardised triage process in the Southeastern Canada, which entailed a times-weekly nurse-physician triage, preordered staging tests and scheduling according to urgency, redirection and recommendations for inappropriate referrals, and new small nodule clinic. 59 Other main effective pathways were the standardised diagnostic pathway for suspected urothelial cancer initiated by primary healthcare providers and specialists in Skane County, Sweden and comprises CT urography, urinary cytology and cystoscopy, 63 the early colonoscopy track (within 30 days from referral) in a tertiary referral hospital in Tenerife, Spain, 12 and the fast-track cancer care pathway in Denmark (national), with maximum acceptable time thresholds from referral to diagnosis and treatment. 39 In addition, two unpublished articles from Canada 111 and the UK 98 focusing on breast and lung cancers, respectively, were identified.…”

Section: Standardised Care Pathwaysmentioning

confidence: 99%

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Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

et al. 2021

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ObjectivesTo summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals.DesignA scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sourcesMEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021.Eligibility and criteriaStudy participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis.Data extraction and synthesisWe summarised findings graphically and descriptively.ResultsFrom 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator.ConclusionsMultidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

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Section: Standardised Care Pathwaysmentioning

confidence: 99%

Section: Standardised Care Pathwaysmentioning

confidence: 99%

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

et al. 2021

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“…Although institutions may share some challenges in achieving timely diagnosis and staging of lung cancer, internal quality assurance studies must be performed at individual centres to ensure their unique challenges are addressed. Several centres in Canada have performed quality assurance investigations of their lung cancer care pathway from onset of symptoms to initial treatment and have published articles detailing strategies that were effective in improving diagnosis time [26,28,[31][32][33]. The most common strategy applied by all centres was the use of centralized referral centres/diagnostic assessment programs and a nurse navigator to help triage patients to the appropriate pathway and coordinate the many investigations needed for diagnosis and staging.…”

Section: Diagnosis and Stagingmentioning

confidence: 99%

“…The most common strategy applied by all centres was the use of centralized referral centres/diagnostic assessment programs and a nurse navigator to help triage patients to the appropriate pathway and coordinate the many investigations needed for diagnosis and staging. Referral programs focused on streamlining diagnostic imaging by scheduling multiple tests on the same day where possible [26,32], improving access to test result reporting [26], pre-ordering or holding designated slots for tests [28,32,33], and triaging testing based on urgency [28,33]. Other strategies focused on education, including increasing awareness of the diagnostic assessment program to the referral base [28], and informing patients of their care path, allowing them to take ownership of their journey [26,32].…”

Section: Diagnosis and Stagingmentioning

confidence: 99%

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

Brade¹,

Jao

et al. 2021

Current Oncology

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Stage III non-small cell lung cancer (NSCLC) comprises a highly heterogenous group of patients with regards to patient fitness and tumour size and distribution, resulting in a wide range of treatment goals and therapy options. Curative-intent multimodality treatment should be considered in all patients with stage III NSCLC. For patients with unresectable disease who are fit, have adequate lung function, and have a disease that can be encompassed within a radical radiation volume, concurrent chemoradiation therapy (cCRT) is the standard of care and can produce cure rates of 20–30%. Recently, consolidation immunotherapy with durvalumab has been recognized as the standard of care following cCRT based on significant improvement rates in overall survival at 4 years. The large heterogeneity of the stage III NSCLC population, along with the need for extensive staging procedures, multidisciplinary care, intensive cCRT, and now consolidation therapy makes the delivery of timely and optimal treatment for these patients complex. Several logistical, communication, and education factors hinder the delivery of guideline-recommended care to patients with stage III unresectable NSCLC. This commentary discusses the potential challenges patients may encounter at different points along their care pathway that can interfere with delivery of curative-intent therapy and suggests strategies for improving care delivery.

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“…For patients from September 2016 to October 2017, we also collected data regarding the number and type of staging imaging, number and type of tissue biopsies for diagnosis and/or staging (e.g., endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), CT-guided biopsy, or percutaneous biopsy of metastatic site). This more limited time frame for evaluation of number and types of staging tests was due to a combination of availability of data and introduction of concurrent improvement processes seeking to standardize the ordering of staging investigations [19], which we felt could be a confounder in the data analysis if further data were to be included.…”

Section: Evaluation Of the Lc MDCmentioning

confidence: 99%

Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic

et al. 2021

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Background: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods: We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016–February 2017) and post-MDC implementation (February 2017–December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results: We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs.

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Improving Timeliness of Lung Cancer Diagnosis and Staging Investigations Through Implementation of Standardized Triage Pathways

Cited by 11 publications

References 18 publications

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic

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