OBJECTIVES: This research analyzed the clinical pathway of patients from a diagnosis of solitary pulmonary nodule including demographics, diagnostic procedures and lung cancer diagnosis through data linkage.

METHODS: REACHnet is one of 9 clinical research networks (CRNs) in PCORnet®, the National Patient-Centered Clinical Research Network and includes electronic health record for over 8 million patients from multiple partner health systems. Data from Ochsner Health System and Tulane Medical Center were linked to Louisiana Tumor Registry (LTR), a statewide population-based cancer registry, for analysis of patient’s clinical pathways. Index date was diagnosis of solitary pulmonary nodule (SPN), low-dose computer tomography (LDCT) or chest computer tomography (CT) between July 2013 and 2017. Patients with lung biopsy and without SPN diagnosis, SPN with pleural biopsy as first biopsy, secondary lung cancer diagnosis, residence outside of Louisiana, Death Certificate diagnosis, and diagnosis on autopsy were excluded.

RESULTS: A total of 30,561 patients with SPN, LDCT or qualifying biopsy were identified and 2,929 (9.58%) had primary lung cancer. 1,496 (51.1%) were documented in LTR. When linking REACHnet and LTR, 94% of 1,496 patients had diagnosis of SPN, 84% had CTs capturing portions of the lung and 89% had 1 or more biopsies. Biopsy distribution was 2.4% surgical, 50.1% bronchoscopy and 47.5% CT guided. Median interval and interquartile from index date to biopsy was 11 days and 28 days respectively. AJCC stage among these patients was Stage 0 (0.53%), Stage I (20.66%), Stage II (7.22%), Stage III (21.86%) Stage IV (47.26%), and Unknown (2.47%).

CONCLUSIONS: Despite clinical workup, 70% of patients were diagnosed as having stage III or IV disease. Approximately half of lung cancer patients receiving care at Ochsner or Tulane healthcare systems do not appear in the LTR. Reasons for this are not clear but are presumed to be attributable to residence.