Fast-Track Diagnostic Pathway for Lung Cancer Detection: Single-Center Experience

Abstract

Objectives: Despite continuous advances in diagnosis, such as the "Two week wait" policy for hospital specialist referral and fast-track diagnostic pathways, lung cancers are detected mostly at advanced stages. Our aim was to evaluate the fast-track diagnostic pathway in a tertiary hospital. Methods: Between March and September 2022, 114 consecutive patients with respiratory symptoms or radiology suspicions of lung cancer were referred to our "Pulmonary Point" outpatient clinic. The time intervals to take in the charges and conduct biopsy and ^18FDGPET-CT were prospectively collected. Furthermore, the patients' experiences were evaluated by means of a six-item questionnaire investigating the outpatient clinic environment and accessibility, the kindness and professional approach of the healthcare professionals, the psychological support provided and an overall evaluation. The data were compared with those of 79 patients observed in the Thoracic Surgery Ambulatory in the pre-COVID-19 pandemic period of March-September 2019 before the fast-track diagnostic pathway for lung cancer was established. Results: The patients were referred to the "Pulmonary Point" outpatient clinic by a General Practitioner in 44 cases (38.5%), by other Specialists in 56 (49.1%) and by an Emergency Department in 14 (12.2%). Among the 114 patients, 104 (91.2%) were visited within 3 working days. Biopsies (FNAB, EBUS, bronchoscopy or surgical) were performed at a median period of 18 days (IQR: 9-26), and ^18FDGPET-CT was carried out at a median period of 16 days (IQR: 7-25). The patients referred to the Thoracic Surgery Ambulatory in the period of March-September 2019 were characterized by longer times to biopsy [26 days (IQR: 12-54), p < 0.001] and to ^18FDGPET-CT [25 days (IQR: 15-38), p = 0.003]. The patients referred in 2022 reported higher scores in the clinic environment (p < 0.001), psychological support provided (p < 0.001) and overall evaluation (p = 0.02) domains of the questionnaire. Conclusions: The establishment of a dedicated diagnostic pathway improves time to diagnosis and patients' satisfaction.

Keywords: diagnostic pathways; lung cancer early diagnosis; multidisciplinary team; patients’ satisfaction; time to 18FDGPET-CT; time to biopsy.

Figure 1

(A). How patients with suspected lung cancer may access the Pulmonary Point outpatient clinic established in 2022 and start the fast-track diagnostic pathway. Pu.Po: Pulmonary Point outpatient clinic. (B). How patients with suspected lung cancer were referred to Hospital Specialists before the Pulmonary Point outpatient clinic access and the fast-track diagnostic pathway started.

Figure 2

Fast-track diagnostic pathway for lung cancer detection. Pu.Po: Pulmonary Point outpatient clinic; EBUS: endobronchial ultrasound; EUS: Endoscopic Ultrasound; FNAB: Fine-Needle Aspiration Biopsy; NSCLC: non-small-cell lung cancer; MDT: multidisciplinary team.

Figure 3

Results of the Satisfaction Questionnaire investigating the outpatient clinic environment and accessibility, the kindness and professional approach of the healthcare professionals, the psychological support provided and overall satisfaction in the two groups of patients observed in 2022 (green bar) and in 2019 (orange bar). The scores for each domain ranged from 0 (very dissatisfied) to 4 (very satisfied). * p < 0.05.