P3.11-18 Implementing One Stop Lung Clinic to Improve Diagnostic Timeliness in Lung Cancer Patients in the North of England

Abstract

Employing just one modification (early use of endobronchial ultrasound) has been shown to improve survival in a randomised controlled trial (Navani et al. Lancet Respir Med 2015). A new innovation set out to implement One Stop lung clinic to reduce diagnostic times as a part of of the Macmillan Integrated Cancer Care Programme on the Lung Cancer Pathway maping started in 2014, which pre-dates the National Optimal Lung Cancer Pathway. Aim of the study was to demonstrate shorter time to diagnosis for patients with suspected lung cancer referred from general practice on a '2 week wait' referral pathway in the UK. Data relating to diagnostic intervals of the patient’s attending One Stop clinic collected and interim analysis performed. The diagnostic intervals were analysed using descriptive analysis to establish the timeliness of intervals from first seen to diagnosis and discussion at the Multi-Disciplinary Team (MDT) meeting. 33 patients attended One Stop clinic and received a CT and then either bronchoscopy, endobronchial ultrasound or pleural aspiration on the same day. 48% (n=15) of patients were diagnosed with a primary lung cancer, 16% (n=5) - with other malignancies including myeloma, lymphoma and colorectal cancer and 32% (n=10) - with non-malignant conditions. The diagnostic intervals from first seen in a lung clinic to diagnosis were in range between 9 and 37days. 39% (n=13) of patients attending the clinic were worked up for the lung MDT discussion within 9 days, 24% (n=8) of patients - within 16 days, 6% (n=2) of patients - within 23 days. In 9% (n=3) of the cases the work up took 30 days or over. 15% (n= 5) were taken off the pathway and 6% (n=2) - were referred for best supportive care. Diagnostic intervals for a cohort of patients attending the clinic were shorter in comparison to England’s National Cancer Standard of 31 days from referral to diagnosis. It is argued that One Stop clinic which involves a CT, then either a bronchoscopy, endobronchial ultrasound or pleural aspiration completed all on the same day reduces the time to diagnosis and improves organisational performance. Interventions for expediting earlier diagnosis of lung cancer need to focus on the compliance of diagnostic services to be all aligned in a rapid one stop environment to improve the earlier diagnosis of lung cancer.