Impact of Anticoagulant and Antiplatelet Therapy on the National Optimal Lung Cancer Pathway (NOLCP).

BACKGROUND

Lung cancer remains the leading cause of cancer-related mortality in the UK, with early diagnosis critical to improving survival. The National Optimal Lung Cancer Pathway (NOLCP) aims to streamline diagnosis and treatment, recently introducing a three-day direct-to-biopsy target for select patients. However, many lung cancer patients are on medications that increase the risk of bleeding (RoB), which may delay biopsy scheduling.

METHODS

A retrospective study was conducted at University Hospitals Plymouth NHS Trust over nine months, evaluating patients who underwent diagnostic procedures leading to a lung cancer diagnosis. Data were collected on referral times, diagnostic intervals, and RoB medication use. Statistical analysis assessed the impact of RoB medications and other factors on time to biopsy.

RESULTS

Of 177 patients undergoing diagnostic procedures, 32 (18%) were on RoB medications, most commonly anticoagulants for atrial fibrillation. The median time from referral to biopsy was 13 days, with only five (15%) meeting the five-day target. While RoB medications did not significantly affect time from referral to biopsy, they did impact clinic-to-biopsy intervals (median 8 vs. 5 days; p=0.022). Only nine (28%) of RoB patients underwent biopsy within five days of clinic, versus 65 (50%) of others who had a final diagnosis of lung cancer. Delays were amplified in patients seen later in the week.

CONCLUSION

RoB medications were associated with meaningful delays from clinic to biopsy, challenging NOLCP's three-day biopsy target. Early identification and proactive management of these patients at triage, along with flexible procedural scheduling, are essential to reduce delays and improve diagnostic timelines.