The lung cancer pathway: seven years of evaluation of multidisciplinary pre-operative management and workflow...

Multidisciplinary management is essential in thoracic oncology to optimize diagnostic assessment, treatment planning, and patient selection for surgery. Structured clinical pathways may improve coordination among specialists and reduce delays in the management of patients with suspected or confirmed lung cancer.

We retrospectively analyzed patients managed within a structured Lung Cancer Pathway (LCP) at Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2018 and December 2024. All patients entering the LCP were included, regardless of final treatment allocation. The pathway involved multidisciplinary assessment including thoracic surgeons, pulmonologists, oncologists, radiologists, pathologists, nuclear medicine specialists, and interventional specialists. The primary endpoints were: -time from LCP initiation to clinical record closure;-time from clinical record closure to surgical intervention.Workflow times were analyzed using median values and interquartile ranges (IQR). Differences between 2018 and 2024 were assessed using the Mann-Whitney U test, while temporal trends across the study period were evaluated using the Kruskal-Wallis test.

A total of 2,691 patients were included. During the study period, the annual number of patients increased progressively, reflecting the expansion of the pathway. The median duration of the LCP significantly decreased from 9 days (IQR 2-23) in 2018 to 1 day (IQR 0-8) in 2024 (p < 0.001). A significant temporal trend was observed across the entire study period (p < 0.001). The median time from LCP closure to surgery was 29 days (IQR 15-43) in 2018 and 35 days (IQR 23-43) in 2024 (p = 0.013). During multidisciplinary evaluation, 447 patients (16.6%) did not proceed to surgery because of advanced disease, comorbidities, functional limitations, or patient preference.

A structured Lung Cancer Pathway was associated with improved efficiency of the diagnostic and decision-making process over a seven-year period. The LCP model allowed standardized evaluation of patients with suspected or confirmed lung cancer, including those ultimately considered unsuitable for surgery. Although the retrospective design does not allow causal inference, these findings support the potential value of structured multidisciplinary pathways in optimizing workflow organization and clinical decision-making in thoracic oncology.