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Implications of a negative bronchoscopy on waiting times to treatment for lung cancer patients: results of a prospective tracking study

^a Department of Cardiothoracic Surgery, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, United Kingdom
^b Department of Clinical Audit, University Hospital of South Manchester, Manchester, United Kingdom

Received 14 September 2007; received in revised form 26 April 2008; accepted 19 May 2008.

^_* Corresponding author. Tel.: +44 161 9803100; fax: +44 161 2912685. (Email: mohandev{at}hotmail.com).

Objective: To ascertain the causes of delays in treatment to all patients presenting to our centre with a working diagnosis of lung cancer. All were entered prospectively into a ‘tracking study’. Methods: Of 342 consecutive confirmed cases of newly diagnosed lung cancer presenting between September 2003 and December 2005, 193 were general practitioner referrals and 149 presented through casualty and internal referrals. The former group formed the basis of the study. Of GP referral patients, 92 had a positive diagnostic bronchoscopy (group Bronch+). Their waiting times were compared with 94 others with negative result (group Bronch–). For uniformity of comparison the non-GP referral patients were excluded from this study. Results: There were no significant differences in the age, clinical presentation or clinical staging of the two groups. Bronch+ had higher proportion of male patients (p = 0.05). Bronch+ group had higher proportion of small cell and squamous cell carcinoma whereas Bronch– group had higher prevalence of adenocarcinoma (p = 0.02). More patients in Bronch– underwent curative (36 vs 18, p = 0.01) intent treatment. Though the median intervals (days) between the referral to first chest outpatient appointments were similar between the two groups (1 vs 1, p = 0.89), the intervals from out-patient to decision-to-treat (33 vs 57, p = 0.001) and decision-to-treat to treatment (8 vs 12, p = 0.05) were significantly longer for Bronch– group. Overall the median referral to treatment interval for Bronch– was significantly longer compared to Bronch+ (45 vs 75, p = 0.001). Most of these delays occurred in the intervals from outpatient appointments to decision-to-treat. Conclusions: A negative initial bronchoscopy in a suspected lung cancer patient implies a greater potential for excessive delays in diagnosis and treatment in spite of a greater chance of curative treatment. Most of the delay occurs in the interval from the outpatient appointment to decision-to-treat. Patients with negative bronchoscopy require a more concerted effort to achieve a timely diagnosis and treatment.

Key Words: Lung cancer • Bronchoscopy • Waiting times