Delays to diagnosis and treatment of lung cancer in Australia

Abstract

Lung cancer is the leading cause of cancer death worldwide, with most patients presenting with advanced stage disease. Missed opportunities for prompt diagnosis leads to increased patient anxiety and distress, under-utilisation of definitive therapy and increased risk of death.

This thesis aimed to identify and address delays occurring in Primary and Secondary healthcare in New South Wales (NSW), Australia. I conducted: 1) A scoping review of the literature evaluating the range and nature of international time intervals to diagnosis and treatment of lung cancer 2) A longitudinal, NSW multi-centre, data linkage study of patient timeframes, against national benchmarks and patient perspectives. 3) A mixed methods substudy exploring clinicians’ reasons for excessive delays observed in (2). 4) A survey of Australian health professionals obtaining insights into perceptions and expectations of timeframes. Major outcomes: • According to literature, major delays generally do not occur in transition from General Practitioner (GP) to specialist care, but moreso within Secondary Care. According to hospital-based clinicians, perceived delays occur in Primary Care, rather than Secondary Care. • Causes of avoidable delays included patient, provider and systemic factors, such as limited coordination in Secondary Care. Unavoidable delays also occur. • Strategies to minimise delays include more lung cancer coordinator positions, review of guidelines, and adjustment of patient and clinician expectations of timeliness.

In summary, most delays in time to diagnosis and treatment of lung cancer occur in Secondary Care. Avoidable delays can be mitigated with better coordination of care. Clinicians and patients perceive delays differently, highlighting a need to set appropriate expectations for time to confirm diagnosis and start treatment for lung cancer. These findings have important implications for the multi-disciplinary care of patients with lung cancer in a changing management landscape.