Jagla Alexandra, Daneshvar Cyrus, McDill Helen, Hassan Maged
Department of Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, GBR.
Department of Respiratory Medicine, Derriford Hospital, Plymouth, GBR.
Cureus. 2025 Sep 12;17(9):e92169. doi: 10.7759/cureus.92169. eCollection 2025 Sep.
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.
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.
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.
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.
在英国，肺癌仍然是癌症相关死亡的主要原因，早期诊断对于提高生存率至关重要。国家最佳肺癌诊疗路径（NOLCP）旨在简化诊断和治疗流程，最近为部分患者引入了三天直接活检的目标。然而，许多肺癌患者正在服用增加出血风险（RoB）的药物，这可能会延迟活检安排。
在普利茅斯大学医院国民保健服务信托基金进行了一项为期九个月的回顾性研究，评估接受导致肺癌诊断的诊断程序的患者。收集了转诊时间、诊断间隔和RoB药物使用情况的数据。统计分析评估了RoB药物和其他因素对活检时间的影响。
在177名接受诊断程序的患者中，32名（18%）正在服用RoB药物，最常见的是用于房颤的抗凝剂。从转诊到活检的中位时间为13天，只有5名（15%）患者达到了五天的目标。虽然RoB药物对从转诊到活检的时间没有显著影响，但它们确实影响了从诊所到活检的间隔（中位时间分别为8天和5天；p=0.022）。在RoB患者中，只有9名（28%）在诊所就诊后五天内接受了活检，而最终诊断为肺癌的其他患者中有65名（50%）。在一周晚些时候就诊的患者中，延迟情况更为严重。
RoB药物与从诊所到活检的显著延迟相关，这对NOLCP的三天活检目标构成了挑战。在分诊时对这些患者进行早期识别和积极管理，以及灵活的程序安排，对于减少延迟和改善诊断时间线至关重要。
