The Lean method as a clinical pathway facilitator in patients with lung cancer

Aasebø, Ulf; Strøm, Hans Henrik; Postmyr, Merete

doi:10.1111/j.1752-699x.2011.00271.x

Cited by 21 publications

(20 citation statements)

References 19 publications

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“…Referral, even if seamless, is an additional medical care step that takes time, and efficiencies might be introduced if this reason is identified with further study at SKCCC. 33 …”

Section: Discussionmentioning

confidence: 99%

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Kanarek

Hooker

Mathieu

et al. 2014

The American Journal of Medicine

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BACKGROUND “Rush to surgery” among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer. METHODS Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable. RESULTS The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00–1.05), stage UB (HR, 2.17; 95% CI, 1.12–4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05–12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21–16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00–1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance. CONCLUSIONS Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.

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“…Referral, even if seamless, is an additional medical care step that takes time, and efficiencies might be introduced if this reason is identified with further study at SKCCC. 33 …”

Section: Discussionmentioning

confidence: 99%

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Kanarek

Hooker

Mathieu

et al. 2014

The American Journal of Medicine

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“…Interventions ranged from the British NHS "2-week wait" system for urgent referral of suspected cancer [45,[48][49][50][51]55], to streamlined outpatient referral triage and staging systems [34,42]. A further seven studies described interventions affecting the treatment interval, ranging from systems described above to nurse-led coordination programmes [39], quality improvement methods [54] and specialised thoracic oncology clinics [57].…”

Section: Effect Of Fast-track Intervention Systemsmentioning

confidence: 99%

How long is too long? A scoping review of health system delays in lung cancer

et al. 2018

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Earlier access to lung cancer specialist (LCS) care improves survival, highlighting the need for streamlined patient referral. International guidelines recommend 14-day maximum time intervals from general practitioner (GP) referral to first LCS appointment ("GP-LCS interval"), and diagnosis to treatment ("treatment interval"). We compared time intervals in lung cancer care against timeframe benchmarks, and explored barriers and facilitators to timely care.We conducted a scoping review of literature from MEDLINE, Embase, Scopus and hand searches. Primary end-points were GP-LCS and treatment intervals. Performance against guidelines and factors responsible for delays were explored. We used descriptive statistics and nonparametric Wilcoxon rank sum tests to compare intervals in studies reporting fast-track interventions.Of 1343 identified studies, 128 full-text articles were eligible. Only 33 (26%) studies reported GP-LCS intervals, with an overall median of 7 days and distributions largely meeting guidelines. Overall, 52 (41%) studies reported treatment intervals, with a median of 27 days, and distributions of times falling short of guidelines. There was no effect of fast-track interventions on reducing time intervals. Lack of symptoms and multiple procedures or specialist visits were suggested causes for delay.Although most patients with lung cancer see a specialist within a reasonable timeframe, treatment commencement is often delayed. There is regional variation in establishing timeliness of care.

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“…Our study addresses a method to reduce time delay from referral for cancer workup to treatment (15, 16). The availability of more efficient equipment is counterweighted by an increasing demand for correct diagnosis at the molecular levels in order to provide personalised treatment (3, 17).…”

Section: Discussionmentioning

confidence: 99%

“…At our unit, we have implemented initiatives to reduce diagnostic delay: all diagnostic workup is performed by pulmonologists skilled in thoracic endoscopy (bronchoscopy, EUS, EBUS) and ultrasound-guided tissue sampling from pleura, liver, spleen, superficial lymph nodes, subcutis, and breasts (19–21). Additionally, bi-weekly MDT conferences facilitate rapid referral to oncology or surgery (5, 16, 18, 22). …”

Section: Discussionmentioning

confidence: 99%

Accuracy and consequences of same-day, invasive lung cancer workup – a retrospective study in patients treated with surgical resection

Madsen

Høegholm

Bødtger

2016

European Clinical Respiratory Journal

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BackgroundThough widely used, little is known about accuracy and efficacy of same-day, invasive workup of suspected lung cancer.ObjectiveTo evaluate the accuracy and efficacy of same-day, invasive lung cancer workup (diagnosis and mediastinal staging), and to identify differences between patients without (Group A) or with (Group B) need for resampling.MethodsA retrospective study was performed on all consecutive patients referred for surgical treatment for localised lung cancer after invasive diagnostic and staging workup at our unit. Data were extracted from electronic medical files. Surgical specimens served as gold standard for correct diagnosis and stage.ResultsA total of 129 patients (peripheral lesion: 84%; mediastinal staging: 97%) were included. After same-day, invasive workup, 71% had no need for further invasive workup (Group A), while 29% had (Group B). Group A differed significantly from Group B in fewer invasive tests, fewer days from referral to surgery, and lower pneumothorax incidence, while no differences were observed in diagnostic accuracy, cancer subtype, tumour size, tumour stage, peripheral lesion, nodal involvement, gender, or presence of chronic obstructive pulmonary disease. Tumour located in right upper lobe was associated with need for resampling.DiscussionOur retrospective study suggests that same-day, invasive workup for lung cancer is safe, accurate, and efficacious in reducing time to therapy, even in patients with small lesions and low tumour burden.

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The Lean method as a clinical pathway facilitator in patients with lung cancer

Abstract: It is feasible to improve patient flow for patients with lung cancer by employing the Lean method as a pathway instrument.

Cited by 21 publications

References 19 publications

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

How long is too long? A scoping review of health system delays in lung cancer

Accuracy and consequences of same-day, invasive lung cancer workup – a retrospective study in patients treated with surgical resection

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