Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral.

Area of Science:

• Oncology
• Healthcare Services Research
• Primary Care Medicine

Background:

• Lung cancer diagnosis is frequently delayed, leading to high mortality rates.
• Timely referral to respiratory specialists is crucial for early lung cancer diagnosis.
• Understanding pre-diagnostic patient pathways in Canadian primary care is limited.

Purpose of the Study:

• To identify and describe the pre-diagnostic pathways of lung cancer patients within primary care.
• To analyze the journey from initial presentation to specialist referral.
• To inform strategies for improving lung cancer diagnostic timelines.

Main Methods:

• Retrospective cohort study of 50 primary lung cancer patients in Montréal, Québec.
• Data collected via chart reviews and patient interviews.
• Latent class analysis used to identify distinct pre-diagnostic pathways.

Main Results:

• Two main pathways identified: "FP-centric" (68%) and "ED-centric" (32%).
• FP-centric pathway referrals took double the time (45 days vs. 22 days) and were associated with more advanced disease (65% vs. 50%).
• In the FP group, 29% had multiple FP visits before referral, and 41% had an ED visit.

Conclusions:

• Findings highlight challenges in primary care lung cancer diagnosis.
• Potential missed opportunities for earlier diagnosis exist.
• The study suggests a potential lack of integration between primary and specialist care.