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Timeliness of cancer care in a regional Victorian health service: a comparison of high-volume (lung) and low-volume (oesophagogastric) tumour streams

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posted on 2021-05-05, 05:56 authored by Mwila KabweMwila Kabwe, Amanda Robinson, Y Shethia, C Parker, R Blum, I Solo, M Leach
Background: Timeliness of cancer care is vital for improved survival and quality of life of patients. Service and care centralisation at larger-volume centres has been associated with improved outcomes. However, there is a lack of systematic data on the impact of tumour stream volume on timeliness of care. Aims: To investigate and compare timeliness of care for lung cancer, a high-volume (more commonly diagnosed) tumour stream, and oesophagogastric (OG) cancer, a low-volume (less commonly diagnosed) tumour stream, at a regional health service in Victoria, Australia. Methods: A retrospective cohort study comprising random samples of 75 people newly diagnosed with lung cancer (International Classification of Diseases and Related Health Problems-10 [ICD-10] diagnosis codes C34 in the Victorian Cancer Registry [VCR]) and 50 people newly diagnosed with OG cancer (ICD-10 diagnosis codes C15 or C16 in VCR) at one regional Victorian health service between 2016 and 2017. Binary logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between patient factors and suboptimal timeliness of care. Results: In comparison to OG cancer patients, lung cancer patients had reduced odds of suboptimal timeliness of care in reference to times outside OCP for referral to diagnosis (OR [95% CI] = 0.34 [0.14 to 0.83]) but increased odds of suboptimal timeliness for diagnosis to treatment (OR [95% CI] = 2.48 [1.01 to 6.09]). Conclusion: In the low-volume OG cancer stream, patients had longer wait times from referral to an MDM, where treatment decisions occur, but shorter time to commencement of first treatment. Conversely in the high-volume lung cancer group, there was delayed initiation of first treatment following presentation at MDM. There is need to explore ways to fast-track MDM presentation and commencement of therapy among people diagnosed with low-volume and high-volume cancers, respectively.


The authors wish to thank the patients whose information was used in this study, the North Eastern Melbourne Integrated Cancer Service (NEMICS) and Southern Melbourne Integrated Cancer Service (SMICS) for their special contributions, the State Government of Victoria for support, and Bendigo Health Care Group for providing access to hospital data sources. Special thanks also to LMICS Project Managers - Optimal Care Pathways, Carol Gibbins and Cheryl Martins.


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