DaPeCa-2: Implementation of fast-track clinical pathways for penile cancer shortens waiting time and accelerates the diagnostic process – A comparative before-and-after study in a tertiary referral centre in Denmark

Abstract

Objective: The aim of this study was to examine the feasibility and impact of a fast-track referral pathway on clinical time intervals in penile cancer. Materials and methods: This observational study from a tertiary referral centre included 263 patients diagnosed before and after the introduction of an intervention to reduce clinical time intervals, the Cancer Patient Pathway (CPP). The CPP included fast-track referral and set time-frames for units participating in cancer diagnosis and treatment, and was introduced for penile cancer in Denmark on 1 January 2009. Median time intervals (in calendar days) with interquartile range were the main outcome measure. Results: A trend towards reduction was observed in all clinical time intervals, with a statistically significant reduction in the system interval (p = 0.01) and tertiary centre interval (p < 0.0001). The proportion of patients treated within the maximum accepted time-frame of 37 days after referral steadily increased after implementation of the CPP. In particular, unjustified waiting time was reduced significantly. This was mainly achieved through pre-booking of appointments and diagnostic time slots by a dedicated clinical coordinator. Conclusions: To the authors’ knowledge, this is the first study examining the feasibility and impact of an intervention to reduce clinical time intervals in penile cancer. The Danish CPP was successful in reducing system and tertiary centre intervals. Future interventions need to address the long patient interval. Longer follow-up is needed to study the impact of CPP on mortality.

Keywords:

• Cancer patient pathway
• clinical pathway
• clinical time intervals
• delay
• penile cancer
• squamous cell carcinoma of the penis
• time intervals
• urgent referral

Acknowledgements

The authors appreciate the pivotal role of the clinical cancer coordinators in the Cancer Patient Pathway and their contribution to the data collection. We acknowledge Dorthe Lund Jensen for assistance with the hospital system.

Declaration of interest: The authors have nothing to disclose. Funding: Aarhus University, Susanne Olesen Foundation & The Beckett Foundation.

Notes