OBJECTIVES : This research analyzed the clinical pathway among patients without lung cancer diagnosis from a diagnosis of solitary pulmonary nodule including demographics, and diagnostic procedures 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 defined as diagnosis of solitary pulmonary nodule (SPN) between July 2013 and December 2017. Patients with a lung biopsy only or pleural biopsy as the first biopsy were excluded.

RESULTS : 24,141 patients with an SPN were identified in REACHnet. After one year of follow-up, 150 (0.6%) had lung cancer diagnosis in LTR but were not identified in the REACHnet database. 8,012 (33.2%) were lost to follow-up and 15,979 (66.2%) received follow-up care for the initial SPN diagnosis. For the 15,979 patients receiving follow up care, 14,610 (91.4%) received SPN procedures or encounters related to their SPN diagnosis. Of these, 94.6% received additional medical consultation, 92% had CT scans or X-ray of the chest and 5.9% had 1 or more biopsies. The distribution of biopsy type was 4.5% surgical, 74.3% bronchoscopy, and 21.2% CT guided.

CONCLUSIONS : Follow-up for clinical outcomes in these information systems is hampered by a high rate of loss to follow-up. Patients with follow-up information are seeking consultation for their original SPN diagnosis. A small proportion of patients with SPN are diagnosed with lung cancer outside of the original healthcare system.