Improving rural lung cancer referral pathways: an assessment of a general practitioner referral pathways programme for patients with lung cancer

BACKGROUND: Lung cancer diagnosis requires multiple investigations, with delays causing increased mortality. To reduce diagnostic delays, a general practitioner (GP) referral pathway programme was developed in 2016 within a rural Australian health district to assist GPs in referring patients with suspected lung cancer for further management. AIMS: To assess the effectiveness of this GP cancer referral programme, and the impact on high-risk patient populations. METHODS: Patients who underwent curative intent radiotherapy for lung cancer at the North NSW Cancer Institute between 2012 and 2022 were included in the study. Patients were stratified based on Eastern Cooperative Oncology Group (ECOG) performance status, stage of malignancy and level of rurality. Comparison was performed between patients diagnosed between 2012-2016, 2017-2019 and 2020-2022. The diagnostic pathway was split into four steps, and the time taken between each point was mapped. Chi-squared analysis was used to assess for demographic differences. Mann Whitney U test was used to assess for differences between the three time periods and between high-risk groups for each step within the diagnostic pathway. RESULTS: There were 214 patients in the study cohort. There were no demographic differences between the three time periods (P > 0.05). ECOG performance status and level of rurality did not impact any step of the diagnostic timeline (P > 0.05). There was an improvement in diagnostic timelines for stage III patients compared to stage I/II patients from 2017 onwards, through multiple steps of the diagnostic pathway (P < 0.05). CONCLUSION: Implementation of a local GP intervention improves diagnostic timelines for patients with advanced stages of disease.