Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study

Stuart Purdie, Nicola Creighton, Kahren Maree White, Deborah Baker, Dan Ewald, Chee Khoon Lee, Alison Lyon, Johnathan Man, David Michail, Alexis Andrew Miller, Lawrence Tan, David Currow, Jane M. Young

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Abstract

Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.

Original languageEnglish
Article number2
Number of pages6
JournalNPJ Primary Care Respiratory Medicine
Volume29
DOIs
Publication statusPublished - 8 Feb 2019
Externally publishedYes

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Keywords

  • lung cancer
  • NSCLC

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    Purdie, S., Creighton, N., White, K. M., Baker, D., Ewald, D., Lee, C. K., Lyon, A., Man, J., Michail, D., Miller, A. A., Tan, L., Currow, D., & Young, J. M. (2019). Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study. NPJ Primary Care Respiratory Medicine, 29, [2]. https://doi.org/10.1038/s41533-018-0113-7