Delays in the assessment and management of primary lung cancers in South Auckland.

Aim To determine the patient characteristics, referral patterns and delays in assessment and treatment of patients with primary lung cancer in South Auckland, New Zealand and compare with international standards. Methods Retrospective review of the clinical records of 80 patients referred to a secondary care respiratory service and diagnosed with primary lung cancer in 2004. Results Eighty-five percent of inpatient referrals and 48.5% of outpatient referrals were for advanced stage lung cancers. The median interval from receipt of outpatient referral to first chest physician assessment was 18 days, with median interval from the first chest physician assessment to bronchoscopy of 17 days and for staging CT chest of 16 days. For patients requiring a CT-guided percutaneous needle aspiration for diagnosis, there was a further median delay of 37 days after the initial CT scan. The median interval from the date of receipt of initial outpatient referral to diagnosis was 38 days, but for early stage lung cancers it was 54 days. The median interval to diagnosis for inpatient admissions was 6 days after the first respiratory assessment Conclusion The intervals for initial assessment, diagnosis and treatment of lung cancer in South Auckland do not meet the recommendations of international guidelines, especially for early stage lung cancers. Organisational and resource changes are required at each point in the diagnostic and management pathway to reduce delays. Lung cancer is the most common cause of death from cancer in New Zealand ( 29.3 deaths per 100,000 people ) 1 There are wide differences in survival between countries, with overall 5-year survival of between 5 and 18% worldwide . New Zealand has a relatively poor average survival rate of 10%, 2 compared with 7% in the United Kingdom, 3 14% in Australia, 4 and 15% in the United States 5 and Canada. 6 This may be in part due to low anticancer treatment rates observed in New Zealand. 7