Author of

• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11972

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    P2.24-026 - Lung cancer pathway at the Royal Adelaide Hospital: Impact of treatment intent and patient location. (ID 1605)

    09:30 - 09:30  |  Author(s): J.R. Ng
    • Abstract

    Background
    A previous 2010 audit at the Royal Adelaide Hospital (RAH) found delays in treatment initiation when compared to targets set in the United Kingdom (UK) National Cancer Plan. The aim of this study was to review our performance in 2011 and to explore the impact of curative or palliative treatment intent and rural or urban based location, in order to guide future improvement.

    Methods
    Using a pathology database, we retrospectively reviewed 128 case notes of patients referred to the RAH in 2011 with new histologically confirmed lung cancer. We identified treatment intent, patient location and key dates in diagnosis and treatment by radiation oncology, medical oncology, cardiothoracic surgery or palliative care before calculating median intervals between these points.

    Results
    Figure 1 52% of patients were urban and 48% rural. 45% of patients were treated with curative intent and 55% with palliative intent. Pertinent median intervals include: referral to appointment (appt): 4 days (inpt: 0 days, outpt: 7 days); appt to diagnosis (a) rural outpt :16 days, urban outpt: 10 days (p=0.58); (b) surgical: 21 days, curative outpt CH-R: 7 days (P<0.001); (c) surgical rural 30.5 days, surgical urban 13 days (p<0.001); referral to treatment: 41 days (UK 2006: 41 days, RAH 2010: 48 days, (a) outpt: 54 days, inpt: 21 days (p<0.0001), (b) surgical: 62 days, outpt curative CH-R: 34 days (p=0.81), curative outpt CH-R: 34 days, palliative outpt CH-R: 46.5 days (p=0.79)). Inpts met both UK targets. There are a number of factors contributing to the delays in surgical cases including a higher proportion of cases needing multiple biopsy attempts and requiring CT-FNA, which takes twice as long to obtain as a bronchoscopy. Rural location did not impact on overall time to treatment but delays seen in appointment to diagnosis, in particular the surgical cases.

    Conclusion
    For 2011, the RAH achieved the first UK targets for first appointment to a specialist but did not meet the target set for referral to commencing treatment. Delays were seen in some rural subgroups, necessitating the need for a streamlined rural pathway to assist in managing investigations and appointments. In turn, this will also reduce the number of rural elective admissions. Initiatives to improve time to treatment with curative intent include pre-booking investigations, utilising EBUS for staging and improving access to CT-FNA. A follow up audit including analysis of mortality is being conducted.