Characteristics, Diagnostic Pathways and Timelines of a Rapid Access Lung Cancer Clinic: A 7-Year Retrospective Cohort Study of 753 Patients
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective: To describe the characteristics, referral pathways and diagnostic timelines of a high-resolution pulmonology consultation (HRPC) for patients with suspected lung cancer, with particular attention to waiting times, referral origins, diagnostic procedures, independent factors associated with cancer and interval to start of treatment. Design: Observational, descriptive, retrospective cohort study. Participants: 753 patients over 16 years of age attended at the HRPC between January 2018 and September 2024, referred for suspected lung cancer or unresolved thoracic lesions. Main measurements: Demographic data, referral origin, time to first visit, number of consultations, diagnostic procedures performed, final clinical diagnosis, time to histological diagnosis, time to discussion at the multidisciplinary tumor committee (MDT) and time to start of treatment. A multivariable binary logistic regression model was fitted on the complete cohort (n=753) to identify independent factors associated with a final lung-cancer diagnosis (with explicit non-causal interpretation). Results: Mean age 66±13 years; 59% male. Main referral reasons: pulmonary nodules (46%), pulmonary masses (18%) and haemoptysis (18%). Referral sources: Radiology (35%; n=264), Primary Care (26%; n=196), Emergency (9%; n=68) and other services (30%; n=225). Time to first consultation: median 3.0 days (IQR 2.0–4.0; mean 3.0±2.0), with an upward trend (2.4 d in 2019 to 4.8 d in 2024). Final diagnosis: lung cancer in 29.7% of referrals (n=224), pulmonary nodules under follow-up in 33% (n=248), benign haemoptysis in 12% (n=90). In the cancer cohort (n=224), median time from first visit to histological diagnosis was 7.7 days (IQR 6.1–9.4), median time from histology to MDT discussion was 5.1 days (IQR 3.8–6.0), and median time from MDT decision to start of treatment was 12.2 days (IQR 9.4–14.7; all 224 cases started treatment within ≤15 days). Median total referral-to-treatment interval was 27.3 days (IQR 24.5–30.5). Multivariable logistic regression identified older age (OR 1.021/yr; 95% CI 1.005–1.038; p=0.012), shorter waiting time (OR 0.838/d; 95% CI 0.765–0.918; p=0.0001; reflecting prioritisation of high-suspicion cases), referral for pulmonary mass (OR 25.51; 95% CI 5.08–128.15; p=0.0001) and referral from Radiology (OR 2.39; 95% CI 1.43–4.01; p=0.001) as independently associated with cancer, whereas referral for pulmonary nodule showed a non-significant trend (OR 4.14; 95% CI 0.83–20.72; p=0.084). Histology: adenocarcinoma 51%, squamous cell carcinoma 20%. 63% presented at advanced stages (III–IV). Conclusions: In this 7-year retrospective cohort the rapid access lung cancer clinic achieved short waiting times to first consultation and to start of treatment, detected lung cancer in approximately 30% of referrals, and integrated Primary Care as the second main referral source. The descriptive design does not allow causal claims about pathway effectiveness, but the data provide reference benchmarks (diagnostic timelines, cancer detection rate, associated factors) that may be useful for other centres implementing similar organizational models and support the need for controlled studies to evaluate their impact on outcomes.
Source: Open Respiratory Archives
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,060
OpenAlex ID: W7220394272