Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Postgrad Med J. 2011 Apr;87(1026):264-8. doi: 10.1136/pgmj.2010.109330. Epub 2011 Jan 27.
Lung cancer is the most common cause of cancer death in the UK, and triaging patients 'straight to test' is recommended to improve patient experience and outcomes. While such pathways are likely to lead to earlier diagnosis and treatment, the data to support this assumption are limited.
To assess the impact of a fast track CT pathway to select patients for lung cancer clinics on clinic efficiency, diagnostic and treatment delays, and patient satisfaction.
Retrospective comparative cohort study of patients referred to lung cancer clinics for investigation of suspicious imaging from January to December 2006 and June to December 2007.
The proportion of patients seen in clinic subsequently diagnosed with lung cancer increased from 124/399 (31%) to 86/168 (51%) (p<0.001). Time from referral to diagnosis reduced from 22 to 17 days (p<0.001). Time from referral to first discussion at the multidisciplinary team (MDT) meeting fell from 32 to 22 days (p<0.001). Time from referral to decision to treat reduced from 42 to 35 days (p<0.05). Time from referral to first treatment fell from 55 to 49 days (p=0.095). The proportion of patients who felt the diagnostic process took too long fell from 15/80 (19%) to 3/49 (6%) (p<0.05).
The new pathway led to more effective use of clinic appointments, reduced diagnostic delay, and more rapid treatment decision times. Patient satisfaction with the speed of the diagnostic process increased. It is recommended that hospital trusts in England consider adopting similar 'straight to test' triaging to select patients for lung cancer clinics.
肺癌是英国癌症死亡的最常见原因，建议对患者进行“直接检测”分诊，以改善患者体验和结果。虽然这样的途径可能会导致更早的诊断和治疗，但支持这一假设的数据有限。
评估快速 CT 途径选择患者进行肺癌诊所就诊对诊所效率、诊断和治疗延迟以及患者满意度的影响。
对 2006 年 1 月至 12 月和 2007 年 6 月至 12 月期间因可疑影像学而转介至肺癌诊所进行检查的患者进行回顾性比较队列研究。
随后在诊所被诊断为肺癌的患者比例从 399 例中的 124 例（31%）增加到 168 例中的 86 例（51%）（p<0.001）。从转诊到诊断的时间从 22 天减少到 17 天（p<0.001）。从转诊到多学科团队（MDT）会议的第一次讨论的时间从 32 天减少到 22 天（p<0.001）。从转诊到治疗决策的时间从 42 天减少到 35 天（p<0.05）。从转诊到第一次治疗的时间从 55 天减少到 49 天（p=0.095）。认为诊断过程耗时过长的患者比例从 80 例中的 15 例（19%）下降到 49 例中的 3 例（6%）（p<0.05）。
新途径导致更有效地利用诊所预约，减少诊断延迟，并更快地做出治疗决策。患者对诊断过程速度的满意度提高。建议英格兰的医院信托考虑采用类似的“直接检测”分诊方法，选择患者进行肺癌诊所就诊。
