Outcome of patients discharged from rapid access lung clinic (RALC) with non cancer diagnosis: Five year follow up

Introduction: Since publication of NICE guidelines in 2000 RALC has become standard practice. These clinics target service towards diagnosis of lung cancer, with streamlined investigation and MDT discussion. We set up our RALC in 2003. Aim: To assess if patients discharged from RALC without a diagnosis of cancer had received adequate care and were not re-presenting with malignancy. Methods: We analysed a random selection of patients discharged from RALC without diagnosis of cancer from 2003-5. Data collected: investigations, duration of follow-up, diagnosis on discharge and 5 year outcome Results: A total of 220 patients were discharged during the study period from or RALC without a diagnosis of lung cancer and 55 were analysed. Male: 28. Average (SD) age 63 (14). CT scan was done in 43 patients (78%) and bronchoscopy in 20 (36%). All the cases were discussed at MDT. 30% of patients were discharged from RALC with 70% discharged to respiratory out patient follow-up. Main diagnoses on discharge were: infection (38%), COPD (15%), benign nodules/plaques (10%), interstitial lung disease (7%), bronchiectasis (7%), vascular (7%), others (15%). Median (range) follow-up in RALC was 24 (0-700) days. 14 (25%) patients died over the 5 years, with average age when first seen of 76 (range 61-86). Cause of death was: non respiratory malignancy (5), cardiac disease (3) and infective causes (6). None of these deaths was related to initial presentation to RALC. No patients developed lung cancer over the duration of study. Conclusion: Our five year follow up study shows that streamlined investigations and MDT input in RALC is effective in ruling out lung cancer.