Reduced specialist time with direct computed tomography for suspected lung cancer in primary care

Lung cancer (LC) is the most common cause of cancer death in Denmark, and triaging patients through fast-track diagnostic pathways is recommended to improve patient outcome. Data on the most efficient triage organisation of such pathways are limited. The aim of this study was to test a strategy of a straight-to-test model for patients referred to the fast-track pathway. Outcomes were number of computed tomographies (CT) performed, use of specialist time and staff acceptability.

We performed a randomised controlled study enrolling 493 patients who were referred from general practice to fast-track LC evaluation (1 January-1 December 2012). Half of the patients were randomly assigned to the intervention and went straight to a chest CT before chest-physician evaluation. Time was measured for patients at random days. Acceptability was examined in a focus group interview.

In the intervention group, 95.5% of patients had a CT performed compared with 97.2% in the control group. There was no difference in the number of CTs between the groups (risk difference (RD) = 1.3% (95% confidence interval (CI): 4.4-2.0; p = 0.454)). In the intervention group, chest-physician time was 13.3 min. (min.-max.: 7.7-19.5 min.) lower per referred patient than in the control group.

Giving general practitioners direct access to a CT did not change the number of CTs performed and significantly reduced chest-physician time per patient. In addition, the strategy was associated with high levels of staff acceptability.

The project was supported by the Danish Cancer Research Foundation, the Danish Cancer Society and the Novo Nordisk Foundation.

ClinicalTrials.gov: NCT01779726.