Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway.
Department of Gynecology, St. Olavs hospital, Trondheim University Hospital, PO Box 3250, Sluppen, NO-7006, Trondheim, Norway.
BMC Health Serv Res. 2019 Sep 18;19(1):679. doi: 10.1186/s12913-019-4517-z.
Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time for lung cancer is 42 days. The aim of this study was to identify reasons for delays and estimate the effect on the timelines when applying an optimal diagnostic pathway.
Retrospective review of medical records of lung cancer patients, with stage I-II at baseline CT, receiving curative treatment (n = 100) at a regional cancer center in Norway.
Only 40% started treatment within 42 days. The most important delays were late referral to PET CT (n = 27) and exercise test (n = 16); repeated diagnostic procedures because bronchoscopy failed (n = 15); and need for further investigations after PET CT (n = 11). The time from referral to PET CT until the final report was 20.5 days in median. Applying current waiting time for PET CT (≤7 days), 48% would have started treatment within 42 days (p = 0.254). "Optimal pathway" was defined as 1) referral to PET CT and exercise test immediately after the CT scan and hospital visit, 2) tumor board discussion to decide diagnostic strategy and treatment, 3) referral to surgery or curative radiotherapy, 4) tissue sampling while waiting to start treatment. Applying the optimal pathway, current waiting time for PET CT and observed waiting times for the other procedures, 80% of patients could have started treatment within 42 days (p < 0.001), and the number of tissue sampling procedures could have been reduced from 112 to 92 (- 16%).
Changing the sequence of investigations would significantly reduce the time until start of treatment in curative lung cancer patients at our hospital and reduce the resources needed.
尽量缩短癌症治疗开始的时间是一个政治目标。在挪威，肺癌的目标时间是 42 天。本研究的目的是确定延迟的原因，并估计应用最佳诊断途径对时间线的影响。
回顾性分析在挪威一家区域癌症中心接受根治性治疗的基线 CT 显示 I-II 期的肺癌患者（n=100）的病历。
只有 40%的患者在 42 天内开始治疗。最重要的延迟是 PET CT（n=27）和运动试验（n=16）的延迟转诊；支气管镜检查失败（n=15）导致重复诊断程序；以及 PET CT 后需要进一步检查（n=11）。从转诊到 PET CT 到最终报告的中位数时间为 20.5 天。如果按照目前 PET CT 的等待时间（≤7 天），48%的患者将在 42 天内开始治疗（p=0.254）。“最佳途径”定义为 1）在 CT 扫描和就诊后立即转诊进行 PET CT 和运动试验，2）肿瘤委员会讨论决定诊断策略和治疗方案，3）转诊进行手术或根治性放疗，4）在等待开始治疗的同时进行组织取样。如果采用最佳途径，目前的 PET CT 等待时间和其他程序的观察等待时间，80%的患者可以在 42 天内开始治疗（p<0.001），并且可以将组织取样程序的数量从 112 减少到 92（减少 16%）。
改变检查的顺序将显著缩短我院根治性肺癌患者的治疗开始时间，并减少所需资源。
