Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
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ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 81-101

The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada


1 Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
2 Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario); Department of Surgery, University of Toronto, Toronto, Ontario, Canada
3 Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario); Department of Surgery, University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Correspondence Address:
Dr. Steven Habbous
Cancer Care Ontario, 525 University Ave, Toronto, Ontario
Canada
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DOI: 10.4103/atm.ATM_283_20

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INTRODUCTION: Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS: Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS: DAP patients were younger (P < 0.0001), had fewer comorbidities (P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76–0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92–1.00]). A longer time until treatment was associated with better overall survival. Conclusion: DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.


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