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Lichtenstein MR, Beauchemin MP, Raghunathan R, Lee S, Doshi SD, Law C, Accordino MK, Elkin EB, Wright JD, Hershman DL. Association Between Copayment Assistance, Insurance Type, Prior Authorization, and Time to Receipt of Oral Anticancer Drugs. JCO Oncol Pract 2024; 20:85-92. [PMID: 38033273 PMCID: PMC10827292 DOI: 10.1200/op.23.00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 12/02/2023] Open
Abstract
PURPOSE Oral anticancer drugs (OACDs) have become increasingly prevalent over the past decade. OACD prescriptions require coordination between payers and providers, which can delay drug receipt. We examined the association between insurance type, pursuit of copayment assistance, pursuit of prior authorization (PA), and time to receipt (TTR) for new OACD prescriptions. METHODS We prospectively collected data on new OACD prescriptions for adult oncology patients from January 1, 2018, to December 31, 2019, including demographic and clinical characteristics, insurance type, and pursuit of PA and copayment assistance. TTR was defined as the number of days from prescription to OACD receipt. We summarized TTR using cumulative incidence and compared TTR by insurance type, pursuit of copayment assistance, and PA activity using the log-rank test. RESULTS Our cohort of 1,024 patients was 53% male, and 40% were younger than 65. Twenty-six percent had commercial insurance only, 16% had Medicaid only, and 59% had Medicare with or without additional insurance. Eighty-six percent of prescriptions were successfully received. Across all prescriptions, 69% involved PA activity, and 21% involved the copayment assistance process. In unadjusted analyses, prescriptions involving the copayment assistance process had longer TTR compared with those not involving assistance (log-rank P value = .005) and OACDs covered by Medicare/commercial insurance had a longer TTR compared with Medicaid (log-rank P value = .006). The PA process was not associated with TTR (log-rank P value = .124). CONCLUSION The process for obtaining OACDs is complex. The copayment assistance process and Medicare/commercial insurance are associated with delayed TTR. New policies are needed to reduce time to OACD receipt.
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Affiliation(s)
- Morgan R.L. Lichtenstein
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Melissa P. Beauchemin
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - Rohit Raghunathan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Shing Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Sahil D. Doshi
- Division of Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Cynthia Law
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Melissa K. Accordino
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - Elena B. Elkin
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Jason D. Wright
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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2
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Denault MH, Labbé C, St-Pierre C, Fournier B, Gagné A, Morillon C, Joubert P, Simard S, Martel S. Wait Times and Survival in Lung Cancer Patients across the Province of Quebec, Canada. Curr Oncol 2022; 29:3187-3199. [PMID: 35621649 PMCID: PMC9140092 DOI: 10.3390/curroncol29050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide, with a five-year survival of 22% in Canada. Guidelines recommend rapid evaluation of patients with suspected lung cancer, but the impact on survival remains unclear. We reviewed medical records of all patients with newly diagnosed lung cancer in four hospital networks across the province of Quebec, Canada, between 1 February and 30 April 2017. Patients were followed for 3 years. Wait times for diagnosis and treatment were collected, and survival analysis using a Cox regression model was conducted. We included 1309 patients, of whom 39% had stage IV non-small cell lung cancer (NSCLC). Median wait times were, in general, significantly shorter in patients with stage III–IV NSCLC or SCLC. Surgery was associated with delays compared to other types of treatments. Median survival was 12.9 (11.1–15.7) months. The multivariate survival model included age, female sex, performance status, histology and stage, treatment, and the time interval between diagnosis and treatment. Longer wait times had a slightly protective to neutral effect on survival, but this was not significant in the stage I–II NSCLC subgroup. Wait times for the diagnosis and treatment of lung cancer were generally within targets. The shorter wait times observed for advanced NSCLC and SCLC might indicate a tendency for clinicians to act quicker on sicker patients. This study did not demonstrate the detrimental effect of longer wait times on survival.
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Affiliation(s)
- Marie-Hélène Denault
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
- BC Cancer Agency-Vancouver Center, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Correspondence:
| | - Catherine Labbé
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Carolle St-Pierre
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Brigitte Fournier
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Andréanne Gagné
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Claudia Morillon
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Philippe Joubert
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Serge Simard
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Simon Martel
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
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3
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Defining timeliness in care for patients with lung cancer: a scoping review. BMJ Open 2022; 12:e056895. [PMID: 35393318 PMCID: PMC8990712 DOI: 10.1136/bmjopen-2021-056895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer. METHODS This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles. RESULTS A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure. CONCLUSION This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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4
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Chiew KL, Sundaresan P, Jalaludin B, Chong S, Vinod SK. Quality indicators in lung cancer: a review and analysis. BMJ Open Qual 2021; 10:bmjoq-2020-001268. [PMID: 34344690 PMCID: PMC8336169 DOI: 10.1136/bmjoq-2020-001268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/25/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kim-Lin Chiew
- Macarthur Cancer Therapy Centre, South Western Sydney Cancer Service, Campbelltown, New South Wales, Australia .,South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shanley Chong
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, South Western Sydney Cancer Service, Liverpool, New South Wales, Australia
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5
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Habbous S, Khan Y, Langer DL, Kaan M, Green B, Forster K, Darling G, Holloway CMB. The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada. Ann Thorac Med 2021; 16:81-101. [PMID: 33680129 PMCID: PMC7908893 DOI: 10.4103/atm.atm_283_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS DAP patients were younger (P < 0.0001), had fewer comorbidities (P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76-0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92-1.00]). A longer time until treatment was associated with better overall survival. CONCLUSION DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.
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Affiliation(s)
- Steven Habbous
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yasir Khan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Deanna L Langer
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Melissa Kaan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Bo Green
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Katharina Forster
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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6
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Menon U, Vedsted P, Zalounina Falborg A, Jensen H, Harrison S, Reguilon I, Barisic A, Bergin RJ, Brewster DH, Butler J, Brustugun OT, Bucher O, Cairnduff V, Gavin A, Grunfeld E, Harland E, Kalsi J, Knudsen AK, Lambe M, Law RJ, Lin Y, Malmberg M, Turner D, Neal RD, White V, Weller D. Time intervals and routes to diagnosis for lung cancer in 10 jurisdictions: cross-sectional study findings from the International Cancer Benchmarking Partnership (ICBP). BMJ Open 2019; 9:e025895. [PMID: 31776134 PMCID: PMC6886977 DOI: 10.1136/bmjopen-2018-025895] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Differences in time intervals to diagnosis and treatment between jurisdictions may contribute to previously reported differences in stage at diagnosis and survival. The International Cancer Benchmarking Partnership Module 4 reports the first international comparison of routes to diagnosis and time intervals from symptom onset until treatment start for patients with lung cancer. DESIGN Newly diagnosed patients with lung cancer, their primary care physicians (PCPs) and cancer treatment specialists (CTSs) were surveyed in Victoria (Australia), Manitoba and Ontario (Canada), Northern Ireland, England, Scotland and Wales (UK), Denmark, Norway and Sweden. Using Wales as the reference jurisdiction, the 50th, 75th and 90th percentiles for intervals were compared using quantile regression adjusted for age, gender and comorbidity. PARTICIPANTS Consecutive newly diagnosed patients with lung cancer, aged ≥40 years, diagnosed between October 2012 and March 2015 were identified through cancer registries. Of 10 203 eligible symptomatic patients contacted, 2631 (27.5%) responded and 2143 (21.0%) were included in the analysis. Data were also available from 1211 (56.6%) of their PCPs and 643 (37.0%) of their CTS. PRIMARY AND SECONDARY OUTCOME MEASURES Interval lengths (days; primary), routes to diagnosis and symptoms (secondary). RESULTS With the exception of Denmark (-49 days), in all other jurisdictions, the median adjusted total interval from symptom onset to treatment, for respondents diagnosed in 2012-2015, was similar to that of Wales (116 days). Denmark had shorter median adjusted primary care interval (-11 days) than Wales (20 days); Sweden had shorter (-20) and Manitoba longer (+40) median adjusted diagnostic intervals compared with Wales (45 days). Denmark (-13), Manitoba (-11), England (-9) and Northern Ireland (-4) had shorter median adjusted treatment intervals than Wales (43 days). The differences were greater for the 10% of patients who waited the longest. Based on overall trends, jurisdictions could be grouped into those with trends of reduced, longer and similar intervals to Wales. The proportion of patients diagnosed following presentation to the PCP ranged from 35% to 75%. CONCLUSION There are differences between jurisdictions in interval to treatment, which are magnified in patients with lung cancer who wait the longest. The data could help jurisdictions develop more focused lung cancer policy and targeted clinical initiatives. Future analysis will explore if these differences in intervals impact on stage or survival.
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Affiliation(s)
- Usha Menon
- Institute for Women's Health, University College London, London, UK
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | - Henry Jensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | | | | | - Andriana Barisic
- Department of Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rebecca J Bergin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - David H Brewster
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK
- Scottish Cancer Registry, Information Services Division, NHS National Services Scotland, Edinburgh, UK
| | | | | | - Oliver Bucher
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Eva Grunfeld
- Health Services Research Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Elizabeth Harland
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats Lambe
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Regional Oncologic Center, University Hospital, Uppsala, Sweden
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Yulan Lin
- European Palliative Care Research Centre (PRC), Olso University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Malmberg
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Donna Turner
- Population Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
| | - Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - David Weller
- Centre for Population Health Sciences, Edinburgh University, Edinburgh, UK
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7
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Purdie S, Creighton N, White KM, Baker D, Ewald D, Lee CK, Lyon A, Man J, Michail D, Miller AA, Tan L, Currow D, Young JM. Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study. NPJ Prim Care Respir Med 2019; 29:2. [PMID: 30737397 PMCID: PMC6368611 DOI: 10.1038/s41533-018-0113-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/06/2018] [Indexed: 11/17/2022] Open
Abstract
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. Examining events leading to the diagnosis of non-small cell lung cancer (NSCLC) in Australia yields insights to guide further research and perhaps improve the pathways to diagnosis. NSCLC is by far the most common form of lung cancer. Researchers, led by the Cancer Institute New South Wales, investigated clinical care contacts leading to diagnosis, using a descriptive cohort study of 894 patients diagnosed between 2006 and 2012. The researchers quantified contact with GPs and lung specialists, hospital admissions and diagnostic imaging procedures. Living in remote locations had little influence on access to services. More than half of the patients did not see a lung specialist during the pathway to diagnosis, while a quarter received their diagnosis in an emergency setting. Further research should investigate whether there are barriers preventing timely diagnosis.
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Affiliation(s)
| | | | | | | | - Dan Ewald
- North Coast Primary Health Network, Ballina, NSW, Australia.,University Centre for Rural Health, Lismore, NSW, Australia
| | - Chee Khoon Lee
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Alison Lyon
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Johnathan Man
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - David Michail
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Alexis Andrew Miller
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia.,Centre for Oncology Informatics, University of Wollongong, Gwynneville, NSW, Australia
| | - Lawrence Tan
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - Jane M Young
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, NSW, Australia
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8
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Shaw T, York S, White K, McGregor D, Rankin N, Hawkey A, Aranda S, Rushton S, Currow D. Defining success factors to describe coordinated care in cancer. Transl Behav Med 2018; 8:357-365. [PMID: 29800413 DOI: 10.1093/tbm/iby022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Providing coordinated care remains a challenge for cancer services globally. There is a lack of consensus in the literature about what constitutes successful coordinated care. This study aimed to define and prioritize a set of consensus-driven success factors that can lead to coordinated care. A mixed-methods approach was used that included literature review, a broad call for submissions from relevant stakeholders, and a priority-setting process based on a modified nominal group technique. Thirty articles that related to success factors in coordinated care were identified in the literature. Twenty submissions were received from a broad range of stakeholders. From these sources, a set of 20 success factors was derived. Seventy stakeholders attended a series of workshops across New South Wales, Australia, to review and prioritize these 20 success factors against significance and measurability. Clear consensus was reached on prioritizing two success factors linked to improving coordinated care from first presentation to diagnosis and ensuring that patients are routinely screened for physical and supportive care needs. Other highly ranked factors included the need for a comprehensive care plan and the identification of patients at higher risk for disjointed care. This study defines and prioritizes a set of success factors related to coordinated care in cancer. These success factors will be used to guide the development of interventions that target improving coordinated care as well as supporting the development of new funding models based on performance indicators derived from these factors.
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Affiliation(s)
- Tim Shaw
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Sarah York
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia
| | | | - Deborah McGregor
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Nicole Rankin
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, Australia.,Cancer Council NSW, Sydney, Australia
| | - Alex Hawkey
- Faculty of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia.,Centre for Health Research, Western Sydney University, Sydney, Australia
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9
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Malalasekera A, Blinman PL, Dhillon HM, Stefanic NA, Grimison P, Jain A, D'Souza M, Kao SC, Vardy JL. Times to Diagnosis and Treatment of Lung Cancer in New South Wales, Australia: A Multicenter, Medicare Data Linkage Study. J Oncol Pract 2018; 14:e621-e630. [PMID: 30207854 DOI: 10.1200/jop.18.00125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Earlier access to lung cancer specialist (LCS) care improves survival. We examined times to diagnosis and treatment of patients with lung cancer in rural and metropolitan New South Wales (NSW) Australia, benchmarked against recent timeframe recommendations. MATERIALS AND METHODS Semistructured interviews of recently diagnosed patients with lung cancer from five NSW cancer centers were used to determine standardized time intervals to diagnosis and treatment, triangulated with Medicare data linkage and medical records. We used descriptive statistics to evaluate the primary end points of median time intervals from general practitioner (GP) referral to first LCS visit (GP-LCS interval) and to treatment start (Secondary Care interval). Univariable and multivariable analyses were used to study associations with delays in end points. Post hoc survival analyses were performed. RESULTS Data linkage was performed for 125 patients (68% stage IV; 69% metropolitan), with 108 interviewed. The median GP-LCS interval was 4 days, with 83% of patients seeing an LCS within the recommended 14 days. The median Secondary Care interval was 42 days (52% within 42 days). There were no significant differences between time intervals faced by rural and metropolitan patients overall, although metropolitan patients took 18 days less than rural counterparts to commence radiation/chemoradiation (95% CI, -33.2 to -2.54; P = .02). One third of patients perceived delays. Delays did not affect survival. CONCLUSION Rural and metropolitan NSW patients face comparable time lines to diagnosis and treatment of lung cancer. Most patients are seen by an LCS within recommended timeframes, but transition through Secondary Care and addressing patient expectations could be improved.
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Affiliation(s)
- Ashanya Malalasekera
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Prunella L Blinman
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Haryana M Dhillon
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Natalie A Stefanic
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Grimison
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ankit Jain
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mario D'Souza
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Steven C Kao
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Janette L Vardy
- University of Sydney, Camperdown; Concord Repatriation General Hospital, Concord West; Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour; and Sydney Local Health District, Sydney, New South Wales, Australia
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The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds. BMC Cancer 2018; 18:754. [PMID: 30031382 PMCID: PMC6054738 DOI: 10.1186/s12885-018-4671-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences. Methods This is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted. Discussion This is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds. Trial registration The project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392, date registered: 4th July 2017).
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