Skip to main content
Top
Published in: Journal of Medical Systems 1/2023

01-12-2023 | Pancreatic Cancer | Original Paper

Fast vs. Regular Track for Lung and Pancreatic Cancer Diagnosis—Time from Initial Finding to Final Diagnosis and Patient Survival

Authors: Orit Rak, Damien Urban, Saritte Perlman, Tomer Ziv-Baran, Eldad Katorza

Published in: Journal of Medical Systems | Issue 1/2023

Login to get access

Abstract

Background

Health systems around the world have begun implementing unique tracks to expedite diagnosis and improve survival of patients with suspected cancers. This study aimed to compare characteristics and survival between patients diagnosed by way of fast and regular diagnostic tracks.

Methods

A historical cohort study of patients (age ≥ 18) diagnosed with lung or pancreatic cancers between 09/2017 and 03/2020 on a fast diagnostic track and treated in a tertiary hospital versus a random sample of patients with the same cancer types who began treatment in the hospital over the same period of time after being diagnosed utilizing the regular track in the community.

Results

The study included 336 patients (108 fast-track diagnostics, 228 regular track diagnostics). Advanced stages III-IV at diagnosis were more likely in the fast-track group (94.4% vs. 81.1%, p = 0.001). The median time from initial cancer suspicion to diagnosis was 21 days (IQR 14–37) for the fast-track vs. 31 days (IQR 18–51) for the regular track (p < 0.001). During the follow-up period, 56 patients from the fast-track and 131 patients from the regular track died. No significant difference was found in the median survival time between the fast and regular tracks, whether from the onset of symptoms, diagnosis, or treatment initiation.

Conclusion

Patients referred to the fast-track were more likely to be diagnosed at a further advanced stage of their cancer. The fast-track shortened the time until diagnosis and treatment but no difference was found in median survival between the tracks, perhaps due to late referral and high fatality rates.
Literature
1.
go back to reference Calanzani N, Weller D, Campbell C. The characteristics of national health initiatives promoting earlier cancer diagnosis among adult populations: a systematic review protocol. BMJ Open. 2017;7(7):e015922.CrossRefPubMedPubMedCentral Calanzani N, Weller D, Campbell C. The characteristics of national health initiatives promoting earlier cancer diagnosis among adult populations: a systematic review protocol. BMJ Open. 2017;7(7):e015922.CrossRefPubMedPubMedCentral
2.
go back to reference Møller H, Gildea C, Meechan D, Rubin G, Round T, Vedsted P. Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study. BMJ. 2015;351:h5102.CrossRefPubMedPubMedCentral Møller H, Gildea C, Meechan D, Rubin G, Round T, Vedsted P. Use of the English urgent referral pathway for suspected cancer and mortality in patients with cancer: cohort study. BMJ. 2015;351:h5102.CrossRefPubMedPubMedCentral
3.
go back to reference Teixeira B, Sequeira T, Gomes M, Silva F, Tomé J. Delays in lung cancer diagnosis and treatment: real-life assessment in a tertiary care center. gecp. 2020;17(2). Teixeira B, Sequeira T, Gomes M, Silva F, Tomé J. Delays in lung cancer diagnosis and treatment: real-life assessment in a tertiary care center. gecp. 2020;17(2).
4.
go back to reference Bleicher RJ, Ruth K, Sigurdson ER, Beck JR, Ross E, Wong Y-N, et al. Time to surgery and breast cancer survival in the united states. JAMA Oncol. 2016;2(3):330-339.CrossRefPubMedPubMedCentral Bleicher RJ, Ruth K, Sigurdson ER, Beck JR, Ross E, Wong Y-N, et al. Time to surgery and breast cancer survival in the united states. JAMA Oncol. 2016;2(3):330-339.CrossRefPubMedPubMedCentral
5.
go back to reference Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, Raymond D, Abraham J, Klein EA, Walsh RM, Monteleone EE, Wei W, Hobbs B, Bolwell BJ. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE. 2019;14(3):e0213209.CrossRefPubMedPubMedCentral Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, Raymond D, Abraham J, Klein EA, Walsh RM, Monteleone EE, Wei W, Hobbs B, Bolwell BJ. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE. 2019;14(3):e0213209.CrossRefPubMedPubMedCentral
6.
go back to reference Grass F, Behm KT, Duchalais E, Crippa J, Spears GM, Harmsen WS, et al. Impact of delay to surgery on survival in stage I-III colon cancer. Eur J Surg Oncol. 2019;1–7. Grass F, Behm KT, Duchalais E, Crippa J, Spears GM, Harmsen WS, et al. Impact of delay to surgery on survival in stage I-III colon cancer. Eur J Surg Oncol. 2019;1–7.
7.
go back to reference Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, et al. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE. 2019;14(3):e0213209.CrossRefPubMedPubMedCentral Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, et al. Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE. 2019;14(3):e0213209.CrossRefPubMedPubMedCentral
8.
go back to reference Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, O’Sullivan DE, Booth CM, Sullivan R, Aggarwal A. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087.CrossRefPubMed Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, O’Sullivan DE, Booth CM, Sullivan R, Aggarwal A. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020;371:m4087.CrossRefPubMed
9.
go back to reference Tsai C-H, Kung P-T, Kuo W-Y, Tsai W-C. Effect of time interval from diagnosis to treatment for non-small cell lung cancer on survival: a national cohort study in Taiwan. BMJ Open. 2020;10(4):e034351.CrossRefPubMedPubMedCentral Tsai C-H, Kung P-T, Kuo W-Y, Tsai W-C. Effect of time interval from diagnosis to treatment for non-small cell lung cancer on survival: a national cohort study in Taiwan. BMJ Open. 2020;10(4):e034351.CrossRefPubMedPubMedCentral
10.
go back to reference Ingeman ML, Christensen MB, Bro F, Knudsen ST, Vedsted P. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer-a cross-sectional study of patient characteristics and cancer probability. BMC Cancer. 2015;15:421.CrossRefPubMedPubMedCentral Ingeman ML, Christensen MB, Bro F, Knudsen ST, Vedsted P. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer-a cross-sectional study of patient characteristics and cancer probability. BMC Cancer. 2015;15:421.CrossRefPubMedPubMedCentral
11.
go back to reference Zhou Y, Mendonca SC, Abel GA, Hamilton W, Walter FM, Johnson S, et al. Variation in “fast-track” referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670,000 patients with cancers of 35 different sites. Br J Cancer. 2018;118(1):24-31.CrossRefPubMed Zhou Y, Mendonca SC, Abel GA, Hamilton W, Walter FM, Johnson S, et al. Variation in “fast-track” referrals for suspected cancer by patient characteristic and cancer diagnosis: evidence from 670,000 patients with cancers of 35 different sites. Br J Cancer. 2018;118(1):24-31.CrossRefPubMed
12.
go back to reference Jensen H, Tørring ML, Vedsted P. Prognostic consequences of implementing cancer patient pathways in Denmark: a comparative cohort study of symptomatic cancer patients in primary care. BMC Cancer. 2017;17(1):627.CrossRefPubMedPubMedCentral Jensen H, Tørring ML, Vedsted P. Prognostic consequences of implementing cancer patient pathways in Denmark: a comparative cohort study of symptomatic cancer patients in primary care. BMC Cancer. 2017;17(1):627.CrossRefPubMedPubMedCentral
13.
go back to reference Jensen H, Vedsted P. Exploration of the possible effect on survival of lead-time associated with implementation of cancer patient pathways among symptomatic first-time cancer patients in Denmark. Cancer Epidemiol. 2017;49:195-201.CrossRefPubMed Jensen H, Vedsted P. Exploration of the possible effect on survival of lead-time associated with implementation of cancer patient pathways among symptomatic first-time cancer patients in Denmark. Cancer Epidemiol. 2017;49:195-201.CrossRefPubMed
14.
go back to reference Villadsen GE, Simonsen K, Ott P, Vilstrup H, Grønbæk H. Effects of implementation of a national fast track clinical pathway for hepatocellular carcinoma in Western Denmark. J Gastrointestin Liver Dis. 2019;28(1):83-88.CrossRefPubMed Villadsen GE, Simonsen K, Ott P, Vilstrup H, Grønbæk H. Effects of implementation of a national fast track clinical pathway for hepatocellular carcinoma in Western Denmark. J Gastrointestin Liver Dis. 2019;28(1):83-88.CrossRefPubMed
15.
go back to reference Alanen V, Koivunen JP. Association of diagnostic delays to survival in lung cancer: single center experience. Acta Oncol. 2019;1–6. Alanen V, Koivunen JP. Association of diagnostic delays to survival in lung cancer: single center experience. Acta Oncol. 2019;1–6.
16.
go back to reference Fallon M, Adil MT, Ahmed K, Whitelaw D, Rashid F, Jambulingam P. Impact of “two-week wait” referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers. Postgrad Med J. 2019;95(1127):470-475.CrossRefPubMed Fallon M, Adil MT, Ahmed K, Whitelaw D, Rashid F, Jambulingam P. Impact of “two-week wait” referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers. Postgrad Med J. 2019;95(1127):470-475.CrossRefPubMed
17.
go back to reference Bin Nun G. Private health insurance policies in Israel: a report on the 2012 Dead Sea Conference. Isr J Health Policy Res. 2013;2(1):25.CrossRef Bin Nun G. Private health insurance policies in Israel: a report on the 2012 Dead Sea Conference. Isr J Health Policy Res. 2013;2(1):25.CrossRef
20.
go back to reference Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649-655.CrossRefPubMed Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649-655.CrossRefPubMed
21.
go back to reference Amin MB, Edge SB, Greene FL, et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2018.156–157,192–194. Amin MB, Edge SB, Greene FL, et al. (Eds.) AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2018.156–157,192–194.
22.
go back to reference Nilssen Y, Brustugun OT, Eriksen MT, Haug ES, Naume B, Møller B. Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016. BMC Cancer. 2020;20(1):488.CrossRefPubMedPubMedCentral Nilssen Y, Brustugun OT, Eriksen MT, Haug ES, Naume B, Møller B. Patient and tumour characteristics associated with inclusion in Cancer patient pathways in Norway in 2015-2016. BMC Cancer. 2020;20(1):488.CrossRefPubMedPubMedCentral
23.
go back to reference Zhu J, Chen R, Davidsson S, Carlsson J, Messing-Eriksson A, Fridfeldt J, Andrén O, Andersson S-O, Valdimarsdóttir U, Fang F, Fall K. Psychological and physiological impacts of a fast-track diagnostic workup for men with suspected prostate cancer: Preliminary report from a randomized clinical trial. Cancer Commun (Lond). 2020;40(5):239–42.CrossRefPubMedPubMedCentral Zhu J, Chen R, Davidsson S, Carlsson J, Messing-Eriksson A, Fridfeldt J, Andrén O, Andersson S-O, Valdimarsdóttir U, Fang F, Fall K. Psychological and physiological impacts of a fast-track diagnostic workup for men with suspected prostate cancer: Preliminary report from a randomized clinical trial. Cancer Commun (Lond). 2020;40(5):239–42.CrossRefPubMedPubMedCentral
24.
go back to reference Moseholm E, Rydahl-Hansen S, Overgaard D, Wengel HS, Frederiksen R, Brandt M, Lindhardt BØ. Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis. Health Qual Life Outcomes. 2016;14:80.CrossRefPubMedPubMedCentral Moseholm E, Rydahl-Hansen S, Overgaard D, Wengel HS, Frederiksen R, Brandt M, Lindhardt BØ. Health-related quality of life, anxiety and depression in the diagnostic phase of suspected cancer, and the influence of diagnosis. Health Qual Life Outcomes. 2016;14:80.CrossRefPubMedPubMedCentral
25.
go back to reference Brocken P, Prins JB, Dekhuijzen PPNR, van der Heijden HF. The faster the better?-A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psycho-Oncology. 2012;21(1):1–10. https://doi.org/10.1002/pon.1929 Brocken P, Prins JB, Dekhuijzen PPNR, van der Heijden HF. The faster the better?-A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psycho-Oncology. 2012;21(1):1–10. https://​doi.​org/​10.​1002/​pon.​1929
Metadata
Title
Fast vs. Regular Track for Lung and Pancreatic Cancer Diagnosis—Time from Initial Finding to Final Diagnosis and Patient Survival
Authors
Orit Rak
Damien Urban
Saritte Perlman
Tomer Ziv-Baran
Eldad Katorza
Publication date
01-12-2023
Publisher
Springer US
Published in
Journal of Medical Systems / Issue 1/2023
Print ISSN: 0148-5598
Electronic ISSN: 1573-689X
DOI
https://doi.org/10.1007/s10916-023-01939-y

Other articles of this Issue 1/2023

Journal of Medical Systems 1/2023 Go to the issue