Surgical Wait-Times for Resectable Lung Cancer.
Recommendations:
For patients with lung cancer whose primary treatment modality is surgical resection, time from referral* for initial consultation to resection should not exceed 6 weeks**.
* We purposefully avoided specifying time from referral to consultation as centres may have different preferences about performing certain investigations prior to consultation or starting with a consultation
** We believe that in the majority of cases, surgeons do have an understanding early on as to which patients will likely be operable and so diagnostic, staging and physiologic investigations can be arranged in parallel making 6 weeks a realistic goal
Discussion / Summary of the literature
Timely care is a fundamental component of quality. Although what constitutes timely care in lung cancer remains a subject of debate, many international/national/regional bodies have set consensus targets for wait times. Given the lack of level I evidence, the committee reviewed various recommendations and adopted one best supported by the available evidence for a Canadian context.
CATS recognizes all too well that thoracic surgeons are only able to achieve timely care if adequate resources (e.g. OR time, CT guided biopsies, imaging resources including PET scans to mention a few) are made available in a timely fashion. CATS also recognizes that local/provincial factors and limitations vary. CATS hopes that adopting such recommendations based on best available evidence helps empower surgeons and care providers to demand the resources they need to deliver quality care
Several guidelines highlighting recommended wait times based on different time intervals in the treatment pathway have been published. The table below highlights some of these guidelines. Two main areas of debate in the wait-times literature persist: 1) the effect of timely care on survival and 2) the ability of healthcare providers to meet established (recommended) wait time guidelines.
No strong association between earlier initiation of anticancer treatment and improved survival has been reported. In addition, recent publication out of McGill University, demonstrated that roughly 60% of patients met the target of first contact, and only 62% of cases were operated on within the recommended time frame (28 days) after being initially seen by a surgeon. Interventions that are associated with improved timeliness include: nurse-led care coordination, access to multidisplinary meetings and a standardized diagnostic process.
| Time Interval | Recommended wait time (days) | ||||
| British Thoracic Society | UK National Health Service | RAND Corporation | American College of Chest Physician | Cancer Care Ontario | |
| Referral → Lung cancer specialist | 7 | 14 | |||
| Lung cancer speciality → Diagnosis | 30 | 35 | |||
| Referral → 1st Treatment | 62 | 62 | 60 | ||
| Lung specialist → Surgery | 56 | 104 | 68 | ||
| Diagnosis → Surgery Consult | 60 | ||||
| Surgery Consult → Surgery | 28 | 14-84 | |||
| Surgery → Adjuvant Chemotherapy | 120 | 120 | |||
| Diagnosis → 1st Treatment | 30 | 31 | 42 | 35 | 52 |
| Diagnosis → Chemotherapy | 28 | 30 | 42 | 39 | |
| Diagnosis → Radiotherapy | 42 | ||||
| Decision to treat → Non-surgical treatment | 7-28 | ||||
| Ready to treat → Radiation | 28 | ||||
Adapted from: Curr Oncol. 2017 October 24(5): 302-309
Recommended Reading
- Kasymjanova G, Small D. Cohen V. et al. Lung Cancer care trajectory at a Canadian center: an evaluation of how wait times affect clinical outcomes. Curr Oncol. 2017 October 24(5): 302-309
- Shakeel S, Dhanoa M, Khan O, Dibajnia P, Akhtar-Danesh N, Behzadi A. Wait times in the management of non-small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis. Can J Surg. 2021 Mar 26;64(2):E218-E227. doi: 10.1503/cjs.013319. PMID: 33769006; PMCID: PMC8064257.
- 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 Apr 29;29(5):3187-3199. doi: 10.3390/curroncol29050259. PMID: 35621649; PMCID: PMC9140092.
References
- Olson JK, Shultz EM, Gould MK. Timeless of care in patient with lung caner: a systematic review. Thorax 2009. Sep; 64(9): 749-56.
- Kasymjanova G, Small D. Cohen V. et al. Lung Cancer care trajectory at a Canadian center: an evaluation of how wait times affect clinical outcomes. Curr Oncol. 2017 October 24(5): 302-309