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NPJ Prim Care Respir Med. 2019 Feb 8;29(1):2. doi: 10.1038/s41533-018-0113-7.

Pathways to diagnosis of non-small cell lung cancer: a descriptive cohort study.

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Cancer Institute NSW, Sydney, NSW, Australia.
Cancer Institute NSW, Sydney, NSW, Australia.
North Coast Primary Health Network, Ballina, NSW, Australia.
University Centre for Rural Health, Lismore, NSW, Australia.
Cancer Care Centre, St George Hospital, Sydney, NSW, Australia.
NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
School of Medicine, Western Sydney University, Sydney, NSW, Australia.
Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.
Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, Australia.
Centre for Oncology Informatics, University of Wollongong, Gwynneville, NSW, Australia.
School of Public Health, University of Sydney, Sydney, NSW, Australia.
Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, NSW, Australia.


Little has been published on the diagnostic and referral pathway for lung cancer in Australia. This study set out to quantify general practitioner (GP) and lung specialist attendance and diagnostic imaging in the lead-up to a diagnosis of non-small cell lung cancer (NSCLC) and identify common pathways to diagnosis in New South Wales (NSW), Australia. We used linked health data for participants of the 45 and Up Study (a NSW population-based cohort study) diagnosed with NSCLC between 2006 and 2012. Our main outcome measures were GP and specialist attendances, X-rays and computed tomography (CT) scans of the chest and lung cancer-related hospital admissions. Among our study cohort (N = 894), 60% (n = 536) had ≥4 GP attendances in the 3 months prior to diagnosis of NSCLC, 56% (n = 505) had GP-ordered imaging (chest X-ray or CT scan), 39% (N = 349) attended a respiratory physician and 11% (N = 102) attended a cardiothoracic surgeon. The two most common pathways to diagnosis, accounting for one in three people, included GP and lung specialist (respiratory physician or cardiothoracic surgeon) involvement. Overall, 25% of people (n = 223) had an emergency hospital admission. For 14% of people (N = 129), an emergency hospital admission was the only event identified on the pathway to diagnosis. We found little effect of remoteness of residence on access to services. This study identified a substantial proportion of people with NSCLC being diagnosed in an emergency setting. Further research is needed to establish whether there were barriers to the timely diagnosis of these cases.

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