Routes to Diagnosis for Lung Cancer in England: Examining the Patient Journey Using Linked Data From Hospital Episode Statistics and the Diagnostic Imaging Database

OBJECTIVES: To examine the diagnostic pathways in patients with lung cancer (LC) in England.

METHODS: Adult patients (≥ 18 years) diagnosed with LC (ICD-10: C34) between 1 April 2018 and 31 March 2019 were included. Linked data from Hospital Episode Statistics (HES) and the Diagnostic Imaging Database (DID) were used. Patients were excluded if they had another primary cancer or no records in DID prior to diagnosis. Records of chest imaging in the six months before diagnosis were extracted using OPCS-4 codes in HES and SNOMED, modality, or NICIP codes in DID. Presence of a code for imaging and a code for body part (i.e., chest) were both required. Average intervals from chest imaging to diagnosis were reported as median days. Proportions of patients via different diagnostic pathways were reported.

RESULTS: A total of 21,052 patients with LC were included, with a mean age of 71 years and 52.8% male. Most (72.8%) started with a chest X-ray (CXR), 11.9% with a CT scan, and 15.4% with same-day CT and CXR. The average interval from the first chest imaging to diagnosis was 56 days. This interval was considerably longer in patients who had multiple CTs or CXRs (84 days), started with a CT scan (92 days), or had a CXR after the initial CT (82 days). It took a median of three chest scans to diagnose, with fewer repeated scans for same-day CT and CXR starters. A third (30.6%) were diagnosed via emergency presentation, and 32.2% attended A&E between the first chest imaging and diagnosis.

CONCLUSIONS: Timeliness of LC diagnosis is critical. This study highlights the disparity in diagnostic pathways and the prolonged time to diagnosis in England, leading to increased healthcare utilisation. Further research is needed to understand the impact of different diagnostic pathways on clinical outcomes in LC patients.