Identifying areas of improvement in the clinical care of early stage lung cancer patients: Discordance of clinical and pathological staging and timeliness of care

ABSTRACT

Aims: Early detection of non-small cell lung cancer (NSCLC) and its surgical excision have the potential to critically reduce the healthcare burden and high mortality rate associated with this malignancy. Realization of this objective is reliant on the efficacy and collaboration of multiple medical disciplines and clinical management pathways. In this study, we have compared clinical and pathological staging of NSCLCs, evaluating lead times between clinical staging and surgery, and data prior to and during the COVID-19 pandemic. Method(s) Records of 417 patients with NSCLC who received curative surgery and whose pathology was evaluated in our hospital between 2016 and 2021 were reviewed. Result(s) Discordance between clinical and pathological TNM staging was 25.9%, including 18.4% cases that were clinically understaged and two patients with undetected stage IVA disease. Median times between staging CT and surgery (105 days (interquartile range (IQR) 77.0-143.0)), PET (78.5 days (IQR 56.0-109.0)) or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and surgery (59 days (IQR 42-94)) indicated that Australian guidelines of <42 days between original referral and commencement of treatment were not being met in the majority of cases. Clinical TNM understaging was significantly associated with time between the final staging study and surgery (p = .023), pleural (p < .05) and vessel (p < .05) invasion, and diagnosis of high grade adenocarcinoma (p=.001). Despite lowCOVID-19 numbers inWestern Australia during the first 2 years of the pandemic, time intervals between CT (p=.0007) or PET (p = .0031) or latest staging study (p = .019) and surgery, were significantly longer during this time. Conclusion(s) Discordance between clinical and pathological staging of NSCLC is associated with tumour histopathological characteristics and treatment delays. While tumour factors that lead to discordant staging cannot be controlled, reduced time to surgerymay have resulted in better outcomes for some patients in this potentially curable lung cancer cohort.