From reactive to proactive lung cancer service delivery model: Implementation of rapid access lung lesion clinic (RALLC) and its clinical impact in a large, regional cancer centre in Australia.

Abstract

Background: Optimal care pathway (OCP) highlights the importance of timeliness to care, stipulating specific timepoints that each component of care must be delivered within. RALLC is an example of a service delivery model that has been adopted widely to improve timeliness to care, but lacks any published standardized framework in Australia, which is reflected in a wide variety of clinics being called RALLC. Here we describe the RALLC model that we implemented in 2017 and present our long-term timeliness and clinical outcome data. Methods: Pre- (2015–16) and post-RALLC (Jul ‘17 – Dec ‘21) data were collected retrospectively, including demographics, OCP timeframes, and clinical outcomes (event free survival for stage I-III, and progression free survival-1 for stage IV disease) and analyzed using descriptive and multivariate analysis. Results: The RALLC team includes lung coordinator, medical oncologist, respiratory physician and thoracic surgeon, running weekly clinic. A centralized referral pathway and referral criteria is utilized, with referrals triaged by an oncologist. Pre-emptive investigations are organized prior to a patient’s first clinic appointment, to maximize relevant clinical information available at first visit where consultation with all relevant sub-specialties occur on the same day. During the study period, 266 patients (53% male, 58% stage I–III, 86% ECOG 0–1) were diagnosed with lung cancer through RALLC, compared with 36 historical controls (55% male, 31% stage I–III, 76% ECOG 0–1). Mean time from referral to first appointment, referral to diagnosis and referral to treatment commencement were 7.5, 20 and 45-days, respectively since implementation of RALLC, compared to 11, 35.5 and 62-days, pre-RALLC. Survival probability combined for all patients improved numerically since RALLC (HR 0.68, p-value 0.15), but most significantly for early-stage patients (HR 0.55, p-value 0.002). Conclusions: This RALLC model incorporates a multidisciplinary team and a pre-emptive investigative approach, expediting diagnosis and treatment. Rapid diagnostic pathway also improves treatment outcome for patients, at least in the early-stage setting.