Impact of COVID-19 on the timeliness to care in a rapid access lung lesions clinic in a large Australian cancer centre.

Abstract

Background: Despite being the fifth most diagnosed cancer, lung cancer has the highest mortality rate in Australia. The Rapid Access Lung Lesion Clinic (RALLC) was developed in our health service in 2017 to streamline assessment, diagnosis and management of patients with a suspected or new diagnosis of lung cancer. Methods: A retrospective review of patients referred to RALLC between 2017 and 2021 was undertaken to assess the impact that the COVID-19 pandemic had on timeliness to care. During this time, 285 patients were referred through RALLC. 19 patients were excluded from analysis as they did not undergo biopsy or were investigated externally. Of the remaining 266, 138 were referred between 2017–2019 (pre-COVID) and 128 between 2020–2021 (during COVID). Results: In terms of cancer stage at diagnosis, the two groups were similar with 60 (43.5%) and 54 (42.2%) patients presenting with stage 1 or 2 disease, 30 (21.7%) and 27 (21.1%) with stage 3 cancer, and 48 (34.8%) and 47 (36.7%) with stage 4 cancer for the pre-COVID and during COVID cohorts respectively. A higher percentage of patients presented with metastatic disease during COVID compared with pre-COVID. The median time from referral to first RALLC appointment was 7 days, referral to diagnosis was 18.5 days, and referral to treatment was 41.5 days in the pre-COVID cohort, compared with 10, 21 and 47.5 days respectively during COVID. These results showed longer median wait times between each point of care during COVID compared with pre-COVID. Conclusions: This review demonstrated that across all timepoints assessed, the median time between each timepoint through RALLC was delayed during the COVID-19 pandemic compared with pre-pandemic wait times. Whether the delays in timeliness to care due to the COVID-19 pandemic resulted in poorer outcomes is currently being investigated at our institution.