Abstract
Lung cancer is the leading cause of cancer death in Canada. The organization of health care services is central to the delivery of accessible, high-quality medical care and may be one factor that influences patient outcome. An exciting opportunity arose for clinicians to initiate the redesign of lung cancer services provided by three institutions in the Greater Toronto Area. This qualitative report describes the integrated lung cancer network that they developed, the innovation it has facilitated, and the systematic approach being taken to evaluate its impact. Available clinical resources were deployed to restructure services along patient-centred lines and to provide greater access to the specialist lung cancer team. A non-hierarchical clinical network was established that consolidates the lung cancer team. A multi-institutional and multidisciplinary tumour board and comprehensive thoracic oncology clinics are at its core. This innovative organizational paradigm considers all of the available services at each facility and aims to fully integrate specialists across the three institutions, thereby maximizing resource utilization. We believe that this paradigm may have wider applicability. The network is currently working to complete a current program of further service improvements and to objectively assess its impact on patient outcome.
Highlights
1.1 Demographics and TreatmentLung cancer is the leading cause of cancer death in Canada, and overall survival has changed little in recent decades
Interest is growing among specialists, patients, and providers concerning the organization and design of lung cancer services, and the effect that improvements might have on patient outcomes, including survival 1
Proponents of the consolidation felt that a multi-institutional, multidisciplinary lung cancer tumour board (LCTB), multidisciplinary lung cancer clinics, and strengthened links between the specialist team and primary care were all central to achieving the stated aims
Summary
Lung cancer is the leading cause of cancer death in Canada, and overall survival has changed little in recent decades. In 2007, an estimated 23,300 new patients will be diagnosed, and 19,900 lung cancer patients will die. For patients diagnosed in 1996– 1998, the age-standardized 5-year relative survival ratio in Ontario was 16%. About 80% of patients develop non-small-cell lung cancer (NSCLC). Patients with operable early-stage NSCLC have the best prognosis, but most patients present with locally advanced or metastatic NSCLC, whose 5-year survival rates are approximately 10% and 5% respectively. Interest is growing among specialists, patients, and providers concerning the organization and design of lung cancer services, and the effect that improvements might have on patient outcomes, including survival 1
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