Countdown to lobectomy: interventions to improve waiting times for lung cancer resection

TL;DR

This study explores how joint clinics and patient pooling can reduce waiting times for lung cancer surgery in Northern Ireland, though national targets remain unmet.

Contribution

The study introduces and evaluates cost-neutral interventions to reduce lung cancer surgery waiting times in a UK regional center.

Findings

Joint clinics and patient pooling reduced the mean time from referral to lobectomy by 27%.

Only 5.8% and 16.3% of patients met the 62- and 31-day waiting time targets, respectively.

Delays in PET scans, biopsies, and between decision to treat and surgery were major contributors to long waits.

Abstract

Prompt diagnosis and treatment are critical to improving outcomes in patients with lung cancer. In Northern Ireland, cancer waiting times are among the worst in the UK. Since 2022, national targets have mandated that definitive treatment should commence within 62 days of referral and within 31 days of the decision to treat (DTT). The present study aimed to evaluate adherence to these standards and to assess the impact of targeted, cost-neutral interventions on waiting times.

We conducted a three-cycle, prospective quality improvement study of patients undergoing lung lobectomy for primary lung cancer at a regional thoracic centre (N = 86). Interventions included the implementation of a joint thoracic surgery–oncology clinic and a patient pooling initiative (cycles 1–2), followed by broader service reorganization (cycles 2–3). Primary outcomes were waiting times relative to the 62- and 31-day targets; secondary outcomes were waiting times for preoperative investigations. A post-Lasso regression was performed to identify which intervals contributed most to overall (62-day) delay.

Following the introduction of joint clinics and patient pooling, the mean time from referral to lobectomy decreased by 27% (from 150.47 to 109.67 days; P = .005, dR = 0.55). No further improvement was observed following service reorganization. There was no change in time from DTT to surgery (all P > .05). Overall, only 5.8% and 16.3% of patients met the 62- and 31-day targets, respectively. Post-Lasso regression identified time to PET and biopsy, as well as delays between DTT, outpatient review, and lobectomy, as significant contributors to overall wait.

Joint clinics and patient pooling initiatives were associated with significant reductions in surgical waiting times; however, compliance with national targets remained poor. While the interventions trialled were ostensibly cost-neutral, further improvement is unlikely without substantive investment in diagnostic infrastructure and operative capacity.

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