|Title:||Audit: Retrospective Review of Time to Treatment Decision for Lung Cancer in the Saolta Group Over a 6 Month Period.|
|Author(s):||P. Ridge; L. O’Loughlin; D. Breen|
|Institution:||Interventional Respiratory Unit, Galway University Hospital (GUH), Galway|
|Poster:||Click to view poster|
Prompt diagnosis and staging of lung cancer is essential for improved patient outcomes1,2. Staging should be achieved with the least and most minimally invasive investigation1. The Lung-BOOST trial confirmed that the upfront use of EBUS for suspected lung cancer confined to the thorax reduced the time to treatment decision by half and was associated with increased survival compared with previous conventional diagnosis and staging2.
EBUS is only available in one unit (GUH) in the Saolta group and there are a finite number of lists per week. All cases of lung cancer are discussed through our lung MDM which allowed us to audit if individual units were achieving a target treatment decision within 14 days of initial CT as set by the Lung-BOOST trial.
We sought to assess if all individual units who discuss their lung cancer cases through our lung cancer multidisciplinary meeting (MDM) in GUH were achieving the key performance indicator of time to treatment decision within 14 days of initial CT. We also sought to identify:
-Time interval from initial CT to subsequent initial investigation
-Time interval to endobronchial ultrasound (if EBUS performed)
-Number of invasive procedures to stage individuals
-Time to reach a histological diagnosis from initial CT
A retrospective review of all the lung cancer cases discussed at our lung MDM from January to June 2018 was performed. All data was recorded and analysed using an anonymised and encrypted Microsoft Excel database.
99 individuals with a new diagnosis of lung cancer were discussed in the MDM over the 6 month period. 56 were from our unit and 43 from other institutions.
Overall the median time for initial investigation post index CT for the Saolta group was 11 days (IQR 2-22.5 days). Median time to EBUS and time to treatment decision was 13 days (IQR 6-40.25 days) and 25 days (IQR 13-43.5 days) respectively.
In the Interventional Respiratory unit in GUH the median time to initial investigation post index CT was 6 days (IQR 0-14). The median time to EBUS and histological diagnosis was 7 days (IQR 1-14) and 11 days (IQR 7-21 days). The median time to treatment decision was 19 days (IQR 11-31)
The only unit with on-site EBUS in the Saolta Group had shorter mean time to treatment decision. However no unit achieved the target of 14 days. This audit indicates a need for greater access to EBUS across the Saolta Group.