Outcomes and characteristics of Danish patients undergoing a lung cancer patient pathway without getting a lung cancer diagnosis. A retrospective cohort study

ABSTRACT

Introduction: The organ-specific Danish cancer patient pathways (CPPs) including standard time frames were introduced in 2008-2009 securing fast tracks for cancer diagnosis and treatment. Previous studies of the CPPs have focussed on patients getting the suspected cancer diagnosis, whereas little is known about patients not getting the cancer diagnosis for which they were examined. We aimed to describe the characteristics of patients who completed a lung cancer CPP (LCPP) without getting a LC diagnosis. Furthermore, to assess the proportion of patients who had invasive procedures performed during the LCPP and radiographic examinations of the chest conducted 30 days prior to the LCPP and during the LCPP. Moreover, we aimed to describe the proportion of patients being diagnosed with any other cancer-type than LC or with non-malignant pulmonary diseases (NMPDs) during the LCPP.

Methods: The study was a retrospective population-based cohort study based on Danish national registers. Patients completing a LCPP between 1 January 2013 and 31 December 2016 without being diagnosed with LC and who were registered as initiating and completing the LCPP, a total of 35,809, were included in the study.

Results: Invasive procedures were performed in 12,986 patients (37.4%) and almost all patients had CT-scans of thorax and lungs conducted 30 days prior to or during the LCPP. During the LCPP other cancer-types than LC were diagnosed in 1,537 patients (4.3% of the study population), including other primary thoracic malignancies in 312 patients, while 6,826 patients (19.1%) were diagnosed with NMPDs, most often infections or chronic respiratory diseases of lower airways.

Conclusion: Besides diagnosing LC the LCPP may contribute significantly in diagnosing other primary and secondary cancers as well as non-malignant diseases.

KEYWORDS:

• Lung cancer
• pathways
• Denmark
• urgent referral
• invasive examinations

Disclosure of potential conflicts of interest

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Therkildsen Ditte Skadhede

Therkildsen Ditte Skadhede is Master Sci. in Public Health and is working as a Senior consultant within the area of health economics. She has previously worked at the Danish Cancer Society within the field of cancer epidemiology.

Christensen Jane

Jane Christensen is Master Sci. in statistics and is statistical consultant within the field of cancer epidemiology at the Danish Cancer Society.

Andersen Ole

Ole Andersen is M.D, specialist in Pediatrics, Doctor Med. Sci., and Master of Health Management. He has previously been consultant and head of department within Pediatrics and consultant at the Danish Health Authority, and adviser at the Norwegian Health Authority, in the Danish Heath Region Zealand, and at the Danish Cancer Society. He is now retired.

Thomsen Linda Aagaard

Linda Aagaard Thomsen is PhD Pharm and head of the Science to Society group at the Danish Cancer Society Research Center focusing on bridging the gap between research and implementation in clinical practice with the aim of improving the clinical, organizational, and patient experienced quality of cancer care. She is an experienced health services researcher with core competences within pharmacoepidemiology, health economics, implementation science, and quality development in health care. She has been PI on a number of studies aimed at development or implementation of complex health care interventions in primary or secondary health care. She is member of the steering committee of the European Cancer League’s Access to Medicines Task Force, member of the program board of the International Cancer Benchmarking Partnership, member of the scientific board for the Danish implementation of the WHO “Medication without harm” initiative, and scientific advisor for the patient representatives of the Danish Medicines Council.

Rasmussen Torben Riis

Torben Riis Rasmussen is M.D, PhD, and clinical associated professor. He is Senior consultant in Pulmonary Medicine at Aarhus University Hospital. He has previously worked as Senior consultant and chairman at Danish Lung Cancer Group.

Christensen Niels Lyhne

Niels Lyhne Christensen is M.D, PhD and clinical associate professor. He is medical doctor at the Department of Pulmonary Medicine and Allergy Aarhus University Hospital. He has previously worked as PhD-student and quest researcher at the Danish Cancer Society.