Background: Lung cancer is the second most common cancer diagnosis in Veterans. Although improvements in diagnostic tools and treatments have led to improved survival rates for all stages of lung cancer, it remains the leading cause of cancer death in both men and women and will account for an estimated one in four cancer deaths for 2017. The overall 5-year survival rate of patients with lung cancer remains poor with slow improving trend towards 20%. Early detection contributes to improved survival rates with a 5-year survival rate of 56.3% for earlier stage lung cancer compared to 4.7% survival rate for patients diagnosed at advanced stages, which still accounts for 57% of cases. It has been posited that delays in diagnosis and treatment of lung cancer have been associated with poor prognosis and survival.
Methods: At the Dayton VAMC, we sought to implement a fast track cancer care pathway for suspicious lung nodules utilizing a VA-designed web-based cancer care tracking system (CCTS), a nurse practitioner and the Chief of Pulmonary Medicine. Established guidelines were used to identify and track suspicious nodules. Suspicious nodules identified on a CAT scan were routed to the Chief of Pulmonary Medicine who assessed the imaging and orchestrated the diagnostic phase.
Results: Nurse navigators began using the CCTS application in the spring of 2017 and, by January 1, 2018, CCTS was fully operational. An Excel spreadsheet was developed to augment the reports from CCTS to document and monitor key metrics including timeliness of treatment and stage at diagnosis. Early data has been encouraging. In fiscal year 2016, the average time from suspicion to treatment was 110 days. The most current data that reflects that has been reduced to an average of 88 days punctuated by a consistent trend toward earlier stage diagnosis.
Conclusions: The diagnostic process for suspicious lung nodules can be complex and involve multiple disciplines and providers, so it is susceptible to delays, often both institutional and patient-driven. Using nurse navigators, a cancer tracking system, and fast tracking suspicious nodules may prevent patients from getting lost in the diagnostic maze resulting in improved timeliness of treatment.
