Cancer Institute NSW, Sydney, NSW, Australia.
North Coast Primary Health Network, Ballina, NSW, Australia.
NPJ Prim Care Respir Med. 2019 Feb 8;29(1):2. doi: 10.1038/s41533-018-0113-7.
Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.
关于澳大利亚肺癌的诊断和转诊途径，相关文献很少。本研究旨在量化在非小细胞肺癌（NSCLC）诊断前，全科医生（GP）和肺部专家的就诊情况和诊断性影像学检查，并确定澳大利亚新南威尔士州（NSW）的常见诊断途径。我们使用了参加 45 岁及以上研究（一项新南威尔士州人群为基础的队列研究）的参与者的相关健康数据，这些参与者在 2006 年至 2012 年间被诊断为 NSCLC。我们的主要观察指标是 GP 和专家就诊、胸部 X 光和计算机断层扫描（CT）以及与肺癌相关的住院治疗。在我们的研究队列中（n=894），60%（n=536）的人在 NSCLC 诊断前的 3 个月内有≥4 次 GP 就诊，56%（n=505）有 GP 开具的影像学检查（胸部 X 光或 CT 扫描），39%（n=349）就诊于呼吸科医生，11%（n=102）就诊于心胸外科医生。诊断途径中最常见的两种途径（占三分之一）包括 GP 和肺部专家（呼吸科医生或心胸外科医生）的参与。总的来说，有 25%的人（n=223）有急诊住院。对于 14%的人（n=129），急诊住院是诊断途径中唯一确定的事件。我们发现居住地点偏远对服务的获取影响不大。本研究发现，相当一部分 NSCLC 患者是在紧急情况下被诊断出来的。需要进一步研究，以确定这些病例是否存在及时诊断的障碍。
