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Varied routes of entry into secondary care and delays in the management of lung cancer in New Zealand
Author(s) -
STEVENS Wendy,
STEVENS Graham,
KOLBE John,
COX Brian
Publication year - 2008
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/j.1743-7563.2008.00158.x
Subject(s) - medicine , interquartile range , lung cancer , palliative care , audit , cancer , secondary care , radiation therapy , emergency medicine , surgery , family medicine , primary care , nursing , management , economics
Aim: To determine secondary care transit times for lung cancer patients, whether these times conformed to international guidelines and the major factors which influenced these times. Methods: An audit of secondary care management in Auckland‐Northland of lung cancer patients diagnosed in 2004 (565 patients) provided the opportunity to assess entry routes into and transit times in secondary care. Results: The most common entry route was via the emergency department (ED) (35%, 198 patients), especially for those with metastatic disease ( P < 0.0005). The median time from entry to diagnosis was 22 days (interquartile range [IQR]: 11; 42) overall, but only 11 days (IQR: 6; 18) when entry occurred via ED. The median time from entry to treatment was 64 days (38; 93); 59 days (36; 87) for palliative treatment and 76 days (50; 111) for curative treatment. Initiation of treatment within British Thoracic Society recommended times occurred for 41% patients undergoing surgical resection, 36% receiving definitive (56% palliative) radiation therapy and 40% receiving chemotherapy. The factors that influenced transit times in multivariate analysis included the entry route, the presenting symptoms, the investigations performed, the tumor type, multidisciplinary discussion and Maori ethnicity. Conclusion: A high proportion of lung cancer patients, especially those treated curatively, were not managed within internationally recommended timeframes. Improved access to primary care may facilitate earlier diagnosis and better resource allocation and prioritizing patients in secondary care may improve the timeliness of treatment for those most likely to benefit from it, thereby improving survival outcomes.