Suspicion of cancer clinic: Community-Based diagnostic system- lung cancer cohort analysis

Delays in lung cancer diagnosis and treatment remain a persistent challenge in community health systems, where fragmented referral pathways and limited coordination may impede timely care. In response to observed delays in diagnostic workup, a community health system implemented a centralized Suspicion of Cancer (SOC) clinic designed to streamline evaluation of patients with suspected malignancy.

We conducted a descriptive observational study of consecutive patients referred to a community-based Suspicion of Cancer Clinic between January 2022 to March 2024. The SOC model incorporates centralized referral triage, rapid imaging review, multidisciplinary coordination, and leadership by a dedicated internal medicine physician with experience as an oncology hospitalist. All referred patients with diagnosed primary lung malignancy were included (n = 77), consistent with an intention-to-treat approach. Time intervals were measured in calendar days across key pathway segments, including referral-to-consult, referral-to-diagnosis, and referral-to-treatment. Interval distributions were summarized using means, medians, interquartile ranges (IQR), standard deviations, and ranges to characterize variability and identify potential delays.

Among 286 patients referred to the SOC clinic for suspicion of lung malignancy during the study period, 77 were diagnosed with primary lung cancer and included in the analysis. The mean referral-to-consult interval was 5.5 calendar days with a median of 6 (3-7) calendar days. The mean referral-to-diagnosis time was 26.2 calendar days with a median of 22 (16-29.75) calendar days. The study group's mean referral-to-treatment was 76.5 calendar days with the median value being 72 (IQR, 53.25-96.25). Demographic and staging data revealed a diverse, community-based population with representation across insurance types and geographic classifications.

The community-based diagnostic system at the Suspicion of Cancer Clinic achieved a median referral-to-diagnosis interval shorter than the NHS Faster Diagnosis Standard while identifying referral-to-treatment intervals that warrant further evaluation. These findings describe that structured, multidisciplinary diagnostic pathways can function effectively outside of academic or nationally integrated systems. The structural components of this model, including centralized triage and dedicated internal medicine leadership, provide a feasible and potentially replicable framework for community health systems seeking to achieve coordination and timeliness in cancer diagnosis.