Variation in lung cancer diagnosis in England

Objective There are several key investigations used in lung cancer diagnosis such as EBUS and PET scanning that some units have better access to than others. Part of the LungPath study aimed to access the degree of this inequality and measure how it affects lung cancer patients. Method Twenty willing NHS Trusts were randomly selected to participate in the LungPath study. Each centre agreed to submit data on each new lung cancer patient seen during the study period of six months. Data collected included anonymised pathology reports from all investigations performed along with clinical data and the dates of all radiological investigations performed. Each individual patient’s diagnostic pathway was mapped using the data collected. In addition, we collected information about typical waiting times for key investigations and whether these investigations were available on-site or at another institution. We analysed the patient pathways from the 20 different centres to see if there were differences in availability and use of Results We found there were dramatic differences in the availability and use of some key investigations, particularly EBUS and PET-scanning. We also found that the stage of the diagnostic pathway that these investigations were used varied and in many cases differed from national guidelines. Conclusion There are marked differences in the availability and use of EBUS and PET-scanning within different centres diagnosing lung cancer in England. There are implications for commissioners for more equal service provision and opportunities for education of clinicians to make best use of these resources.