P1.16-22 Reduced Delays in Diagnostic Pathways for Non-Small Cell Lung Cancer After Local and National Interventions

Abstract

Patients with non-small cell lung cancer (NSCLC) may experience progression and stage shift due to delays in a complex and time-consuming diagnostic work-up. We have analyzed the impact of both a local and national intervention on total time to treatment (TTT) for a population-based cohort of NSCLC patients. All patients diagnosed with NSCLC at a county hospital in Kristiansand, Norway, 2007-2016 were reviewed. The period 2007-12 before the interventions was defined as baseline. Local bottlenecks in the diagnostic pathways were identified and a new, locally developed diagnostic algorithm introduced from 2013. From 2015 National diagnostic cancer pathways were implemented and local adjustments were made accordingly. TTT defined as time from referral of the primary physician to treatment was compared in the three diagnostic time periods; baseline period (2007-12), local initiative (2013-14) and the national initiative (2015-16). Multivariable quantile regression was used to correct for possible confounding factors. A total of 780 NSCLC patients were included in the study. The median TTT decreased from 46 days in the first period to 35 days in the last period. Among patients treated with curative intent the median TTT decreased by 21 days, from 64 to 43 days (p<0.001) while the mean number of procedures increased from 3,5 to 3,9. In median regression analysis, the local intervention was associated with a reduction of 7.7 days (95% CI 3.2, 12.3) in TTT, while the national intervention had a reduction of 14.9 days (95% CI 10.2, 19.6) compared to the baseline group. Examining the 75thand 90thpercentile, the last period had 22 days and 27 days shorter TTT than the first period, respectively. Covariates associated with longer TTT were stage I (21.3 days compared to stage IV), use of PET-CT (10.6 days), diagnostic procedure at external hospital (13.0 days), and additional number of diagnostic procedures (5.3 days per procedure). Both interventions, the local and national initiatives introduced to this population significantly reduced TTT in NSCLC despite more diagnostic procedures being added to the work-up. The effect was most pronounced among patients with disease available for curative treatment.