Download Abstract 2

Lung Cancer – Delays in Diagnosis and Treatment in 2013
Galea R., Casha A. Galea J
Introduction:
Lung cancer is the most common cause of death by cancer worldwide including Malta.
Delays in diagnosing lung cancer may contribute to advanced stage at diagnosis and poor
long term survival. In 1998, the NHS England recommended that patients suspected of
having cancer should receive first treatment of cancer within 62 days of urgent GP referral, to
improve outcomes in staging and treatment. The proposed standard was for at least 85% of
the affected population to reach this 62 day target.
Aim:
To undertake an audit to assess the duration from presentation to surgical resection of lung
cancer in Malta in the year 2013, and to compare this to the initial audit carried out by Mr A
Casha in 2005. To assess whether the waiting times in Malta reaches the 62 day target set by
the NHS on improving outcomes in cancer and to implement changes to improve compliance
with standards if necessary.
Methodology:
The data required for the audit was collected retrospectively. A list of the patients operated by
the cardiothoracic department (including every firm) in 2013 was collected and the patients
that underwent wedge excisions, lobectomies and pneumonectomies for primary lung cancer
were noted. The case notes of these selected patients were retrieved and analysed
retrospectively to obtain information regarding the timing from initial presentation to surgery.
The patients who underwent surgical resection of lung cancer were divided into two groups:
those who presented to a primary health center or to the accident and emergency department
with symptoms caused by the lung cancer, and those patients who were asymptomatic but
were diagnosed incidentally while investigating other illness.
For both patient groups the time intervals between presentation to surgery, and the steps in
between these stages including referrals and investigations, were calculated in days. These
intervals were compared to those obtained in the initial audit performed in 2005/6 by Mr A.
Casha to determine if there were any improvements since then. The results of both were then
analysed to assess whether the standard target time recommended by the NHS was reached.
Results:
17 patients were operated for lung cancer resection in 2013, 9 of which presented to the GP
or A&E with symptoms secondary to the lung cancer (Group A). The other 8 patients that
underwent lung cancer resection in 2013 were diagnosed after the lung cancer was found
incidentally (Group B).
The average time in days from presentation with symptoms to the first tentative diagnosis for
patients in group A was 13 days (median: 7 days). In 2005, the average was 71 days
(median: 30 days). This shows that patients with lung cancer are presenting to their GP/A&E
earlier.
Time from diagnosis to referral to cardiothoracic
2013
Average: 85 days
2005
Average: 65 days
surgeon
Time from referral to surgical services to day of
lung cancer resection
Time from presentation of symptoms/incidental
finding of lung cancer to surgery
% treated within 62 days of diagnosis
Median: 43 days
Average: 15 days
Median: 9 days
Average: 101 days
Median: 69 days
35%
Median: 35 days
Average: 11 days
Median: 12 days
Average: 108 days
Median: 81 days
56%
41% of patients operated in 2013 were referred to the respiratory physician through the rapid
access clinic, and of these 57% were treated within 62 days of diagnosis.
2 patients were seen by the cardiothoracic surgeon privately and 1 patient was diagnosed
incidentally by a respiratory physician and hence these patients did not need rapid access
clinic referral.
The 7 remaining patients were not referred through the rapid access clinic and of these only
14% were treated within 62 days of diagnosis of lung cancer.
Discussion:
The audit reveals that not enough patients with lung cancer were being treated within 62 days
of diagnosis in 2013. Another important point is that not enough patients were being referred
to the respiratory physician through the rapid access clinic, therefore further delaying
confirmation, staging and treatment of the lung cancer.
Compared to 2005, in 2013 more patients presented earlier to their GP/A&E however many
still were not referred to the respiratory physician and cardiothoracic surgeon early enough to
be treated within 62 days of diagnosis.