Timeliness of lung cancer treatment utilizing the rapid access lung cancer clinic in a regional Australian Hospital.

Abstract

Background: Patients in remote and rural areas of Australia are disadvantaged in receiving and accessing healthcare. Lung cancer incidence and mortality is increased in remote areas compared to metropolitan regions. The rapid access lung cancer (RALC) clinic was established in 2017 in order to optimize timeliness to treatment and improve patient outcomes.

Methods: Retrospective audit of all patients diagnosed with lung cancer in 2018 within the Ballarat Health service and was stratified according to stage of cancer. Mean timeframes were derived from the Australian optimal care pathway (OCP) for people with lung cancer and analysed using descriptive statistics.

Results: Total of 84 patients were diagnosed with lung cancer in 2018, with 72% being seen in the RALC clinic. Overall 77.3% met the OCP timeframe of referral to treatment in less than 42 days as compared to only 48.5% in 2015-2016. Stage I/II, III and stage IV patients had mean referral to treatment intervals of 53, 40 and 22 days respectively. Stage IV RALC patients compared to general clinic patients, proceeded to treatment faster after diagnosis (7 days vs 28 days, p = 0.04) and were presented at MDT more frequently (44.5% vs 13.5%). In Stage I/II and stage III patients who had delays from diagnosis to treatment, main reasons were waiting times for surgery, radiotherapy and further diagnostic test. Limitations of a regional centre include having to refer externally for both EBUS and complex surgery offered only in metropolitan hospitals.

Conclusions: RALC clinics have reduced time to definitive treatment. Early stage patients require more complex work up and multi-modality treatment, so have a longer time to first treatment over advanced stage patients. Despite the obstacles of a regional centre, the time to treatment were shorter that of metropolitan public hospitals. Longer follow-up will determine if improved timeliness will lead to better patient outcomes.