Largey Geraldine, Ristevski Eli, Chambers Helen, Davis Heather, Briggs Peter
Southern Melbourne Integrated Cancer Service (SMICS), PO Box 72, 823-865 Centre Road, East Bentleigh, Vic. 3165, Australia.
Monash University Department of Rural & Indigenous Health (MUDRIH), 3 Ollerton Avenue, Moe, Vic. 3825, Australia. Email: ; ;
Aust Health Rev. 2016 Jan;40(6):649-654. doi: 10.1071/AH15220.
Objective The aim of the present study was to compare lung cancer diagnostic and treatment intervals with agreed target measures across three large public health services in Victoria and assess any differences in interval times by treatment type and health service. Methods A retrospective medical record audit of 78 patients admitted with a new diagnosis of lung cancer was conducted. Interval times from referral to diagnosis, diagnosis to first treatment and referral to first treatment were recorded in three treatment types: surgery, chemotherapy and radiotherapy. Results There was a significant difference in the mean number of days from referral to diagnosis by treatment type. Patients who underwent surgery waited significantly longer (mean (± s.d.) 41.6±38.4 days) to obtain a diagnosis than those who received radiotherapy (15.1±18.6 days). Only 47% of surgical patients obtained a diagnosis within the recommended 28 days. Moreover, only 45% and 44% of patients, respectively, met the diagnosis-to-treatment target of 14 days and referral-to-treatment target of 42 days. Conclusion The present study highlights the effect of treatment type on lung cancer referral interval times. It demonstrates the benefits of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. What is known about the topic? Lung cancer is the leading cause of cancer mortality in Australia and has the lowest 5-year survival rate of all cancer types. Delays in the diagnosis of lung cancer can change the prognosis from potentially curable to incurable, particularly in faster-growing tumours. What does this paper add? This study reveals treatment type was a greater factor in explaining variations in diagnosis and treatment than health service. Surgical patients were consistently lower in meeting the recommended interval targets across referral to diagnosis, diagnosis to treatment and referral to treatment. What are the implications for practitioners? This study demonstrates the value of using evidenced-based interval target times to benchmark and compare performance outcomes in lung cancer. Such measures may further improve prognostic outcomes in lung cancer by reducing unwanted delays.
目的 本研究旨在比较维多利亚州三大公共卫生服务机构中肺癌诊断和治疗间隔与商定的目标指标,并评估不同治疗类型和卫生服务机构在间隔时间上的差异。方法 对78例新诊断为肺癌的住院患者进行回顾性病历审核。记录了三种治疗类型(手术、化疗和放疗)从转诊到诊断、从诊断到首次治疗以及从转诊到首次治疗的间隔时间。结果 不同治疗类型从转诊到诊断的平均天数存在显著差异。接受手术的患者获得诊断的等待时间(平均(±标准差)41.6±38.4天)明显长于接受放疗的患者(15.1±18.6天)。只有47%的手术患者在推荐的28天内获得诊断。此外,分别只有45%和44%的患者达到了14天的诊断到治疗目标和42天的转诊到治疗目标。结论 本研究突出了治疗类型对肺癌转诊间隔时间的影响。它证明了使用基于证据的间隔目标时间来衡量和比较肺癌治疗效果的益处。关于该主题已知的信息是什么?肺癌是澳大利亚癌症死亡的主要原因,并且在所有癌症类型中5年生存率最低。肺癌诊断的延迟会使预后从可能治愈变为无法治愈,特别是在生长较快的肿瘤中。本文补充了什么?本研究表明,治疗类型比卫生服务机构更能解释诊断和治疗差异。手术患者在转诊到诊断、诊断到治疗以及转诊到治疗方面达到推荐间隔目标的比例一直较低。对从业者有何启示?本研究证明了使用基于证据的间隔目标时间来衡量和比较肺癌治疗效果的价值。这些措施可能通过减少不必要的延迟进一步改善肺癌的预后结果。