Clinical quality indicators of pathways to oncological lung surgery

Multidisciplinary team (MDT) meetings are a standard of care for lung cancer management in many regions around the world. Clinical quality indicators (CQIs) can be used to assess the proficiency of these multidisciplinary teams and compare their performance against those recommended by local and international guidelines. The effectiveness of the lung cancer MDT meeting at Dunedin Public Hospital has been evaluated using CQIs with a focus on the timeliness of surgical management.

Medical records for all 108 patients who underwent curative intent oncological lung surgery at Dunedin Public Hospital between 2014-2020 were obtained. All patients were discussed at the lung cancer MDT meeting. Performance in six CQIs were evaluated as per the results below.

The CQI for timing of referral to first contact with a respiratory medicine specialist was met in all years studied by mean days. In all years bars for 2014 and 2017, the standard for time by mean days from referral date to surgery was met. In 2017, the mean time to surgery exceeded this standard by only one day. The mean time between respiratory specialist review and surgery was less than 56 days in all years except for 2014. By mean days, 2018 was the only year that surgery was performed within 31 days of discussion at the lung cancer MDT. Computed tomography (CT) guided biopsies and endobronchial ultrasound (EBUS) were only performed within a mean of seven days in only two years (2015 and 2017) out of the seven years of data. The target of all patients with curative small or non-small cell lung cancer receiving a positron emission tomography (PET) scan was not achieved in any year. Post-operative upstaging was more frequent than downstaging (19.4% vs 14.8%), and 71.4% of those upstaged received a PET scan pre-operatively. Māori patients and those with significant socio-economic deprivation were less likely to meet standards of lung cancer care.

Between 2014-2020, the standards for lung cancer management in surgical patients were frequently achieved as measured by mean days. However, a target of ≥95% (90% for CQI 2; 100% for CQI 6) of patients receiving care at the standard was rarely met. Timing of CT biopsy and EBUS was consistently longer than recommended, and pre-operative PET utilisation was less than 100%. Thus, there is still room for improvement in surgical lung cancer management in the Southern Health District.