LUNG CANCER PATHWAY ANALYSIS IN A LARGE NHS TRUST IN NORTH WEST ENGLAND.

Introduction and Objective; Lung cancer mortality rates are higher in the north of England, compared to the rest of the UK. National guidance for Lung Cancer, define target times for referral-to-treatment. These targets have since come under scrutiny under the public eye, with particular media attention on slow referrals from family doctors. Method; We investigated reasons for failing to achieve two week wait (TWW) and 62 day referral-to-treatment targets in a large hospital trust (population 900,000) via retrospective case note analysis. Results and Conclusions; During a one year period, 39 of 550 lung cancer patients breached the target pathway. 4/39 (10%) breached the TWW and 33/39 (85%) breached our internal standard of 21 days from referral to completion of initial investigation. Median “time from request to investigation” in days(range) were as follows: CT 7(2-14), PET-CT 7(1-13), bronchoscopy 7(1-8) and CT-biopsy 11(5-29). 19/39 (50%) breached the 31 day secondary referral-to-treatment target. Median waiting time to initial tertiary care appointment was 10 days(5-26). Primary reasons for breaches were secondary care delays (42%) including inadequate preparation for biopsy and administrative errors (2 patients each, respectively) and delays within tertiary care (18%). In the public eye, there is a misconception of delays in diagnosis and management at primary care level lying with the experience of the family doctor. In our study, we have found this to not be the case, as delays of note included: time to CT-biopsy and waiting time to appointment with a tertiary care clinician from point of referral.