Implementation of the British Thoracic Society recommendations for organising the care of patients with lung cancer: the surgeon's perspective

Background: The British Thoracic Society (BTS) recognises that it is of paramount importance to ensure that all patients with a working diagnosis of lung cancer have access to first class care [The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. BTS recommendations to respiratory physicians for organising the care of patients with lung cancer. Thorax 1998; 53 (Suppl 1): S1-8]. Methods: A retrospective audit of the time involved in the management of patients with lung cancer referred for consideration of surgery at the Royal Brompton Hospital was carried out. Our performance was compared with the BTS recommendations. Results: The notes from 194 patients were analysed, accounting for 93.7% of patients referred with lung cancer in a 1-year period. A total of 90 patients fulfilled the criteria for analysis as they had potentially resectable disease at referral; 59 (65.5%) underwent thoracotomy, and 31 (34.5%) were considered inoperable. The median interval between the onset of symptoms and their first chest radiograph was 39 days, and between the onset of symptoms and referral to a surgeon by a chest physician was 112 days. The median interval between referral by a respiratory physician and surgical out-patient attendance was 14 days, and between referral by a respiratory physician and the surgical procedure was 32.5 days. The median length of time from surgical out-patient attendance to the surgical procedure was 17 days. There was no association between the interval between the onset of symptoms and the surgical procedure with advanced tumour stage at surgery. Conclusions: There are a number of sources of delay in the referral process for a patient with potentially resectable lung cancer. Most patients referred to our unit were treated within the time scale recommended by the BTS. Our survey has shown that there are cumulative delays in the overall investigation and management of lung cancer patients, which are not covered by the BTS guidelines, and which result in unacceptable delays for most patients.