Improving timeliness of lung cancer care through a rapid assessment clinic

BACKGROUND: Early diagnosis and treatment of lung cancer improve survival. Guidelines from Australia and worldwide stipulate timeframes of care from referral. The Rapid Lung Assessment Clinic (RLAC) was established to fast-track the diagnostic and treatment pathway, with a subsequent quality improvement initiative based on the initial analysis of timeliness of care. AIM: This study evaluated the performance of RLAC before and after the quality improvement initiative and identified patient and system factors, which affect timeliness of care. METHODS: This was a retrospective, observational cohort study evaluating RLAC. The clinic was established in 2018 as a weekly clinic serviced by respiratory physicians associated with the hospital's lung cancer multidisciplinary team. In 2020, the service gained access to a dedicated nurse coordinator who organised pre-clinic positron emission tomography scan and/or other investigations prior to clinic appointment. RESULTS: Median times from referral to specialist review (11 vs 10 days, P = 0.02 (before vs after intervention)), diagnosis (28 vs 21 days, P = 0.5) and treatment (63 vs 51 days, P = 0.001) were all reduced after intervention. Before and after the intervention, 71% (before intervention) versus 74% (after intervention) of patients had specialist review within 14 days, and 29% versus 40% commenced treatment within 42 days. Earlier stage of disease, need for surgical treatment and greater number of diagnostic investigations was associated with longer times to treatment. CONCLUSION: Our intervention reduced delays to treatment of lung cancer in a rapid assessment clinic. The majority of patients were still not treated within recommended timeframes, raising the question of whether guideline timeframes are realistic given the modern-day complexities of lung cancer work-up.