Times to Diagnosis and Treatment of Lung Cancer in New South Wales, Australia: A Multicenter, Medicare Data Linkage Study

Abstract

Introduction: Earlier access to lung cancer specialist (LCS) care improves survival. We examined times to diagnosis and treatment of patients with lung cancer in rural and metropolitan New South Wales (NSW) Australia, benchmarked against recent timeframe recommendations. Materials and Methods: Semistructured interviews of recently diagnosed patients with lung cancer from five NSW cancer centers were used to determine standardized time intervals to diagnosis and treatment, triangulated with Medicare data linkage and medical records. We used descriptive statistics to evaluate the primary end points of median time intervals from general practitioner (GP) referral to first LCS visit (GP-LCS interval) and to treatment start (Secondary Care interval). Univariable and multivariable analyses were used to study associations with delays in end points. Post hoc survival analyses were performed. Results: Data linkage was performed for 125 patients (68% stage IV; 69% metropolitan), with 108 interviewed. The median GP-LCS interval was 4 days, with 83% of patients seeing an LCS within the recommended 14 days. The median Secondary Care interval was 42 days (52% within 42 days). There were no significant differences between time intervals faced by rural and metropolitan patients overall, although metropolitan patients took 18 days less than rural counterparts to commence radiation/chemoradiation (95% CI, −33.2 to −2.54; P = .02). One third of patients perceived delays. Delays did not affect survival. Conclusion: Rural and metropolitan NSW patients face comparable time lines to diagnosis and treatment of lung cancer. Most patients are seen by an LCS within recommended timeframes, but transition through Secondary Care and addressing patient expectations could be improved.