A medical center's redesigned lung cancer management protocol decreased both the time to diagnosis and the time from diagnosis to actual treatment to less than 20 days, according to a new study.
"Although 215,000 new cases of lung cancer were diagnosed in 2008, past studies have shown that this diagnosis can take up to 4 months after a suspicious finding, especially if patients are undergoing consecutive procedures," said Ivy Tuason, RN, MSN, FNP, from Pomona Valley Hospital Medical Center in Pomona, California, during her presentation. "Many lung cancers are just found too late for successful treatment." She reported that be cause her center often did not perform timely followups on suspicious chest x-ray (CXR) findings coming from emergency department visits, preoperative testing, and other routine tests, her team sought to expedite this process through a new lung cancer program. The process put in place through the new program included hiring an advanced practice nurse (APN) to lead the program and to determine whether a patient needed further work-up based on daily reports of abnormal CXRs and computed tomography (CT) chest scans. The APN then followed-up on each case until a diagnosis was made. In addition to the new protocol, the team also created and implemented a color-coded intranet webpage, called "virtual tumor board," to function as a central repository where the physicians could review patient radiographs and evaluations. "We wanted to create an automated solution to the issue of accelerating the time it takes for multiple cancer care physicians to review data and, ultimately, determine the correct course of treatment," Tuason explained. Finally, the team started creating a series of short web-based patient-education videos, targeting those who were newly diagnosed and featuring providers from the Pomona Valley Hospital Medical Center. "We felt that patients would be able to better relate to the information if their actual providers were the ones featured as content experts," Tuason said. The overall aim of the new program was to decrease diagnosis time to less than 25 days and decrease time from diagnosis to treatment to less than 25 days. In an evaluation of 103 patients going through the new protocol between August 2008 and August 2009, the investigators found that the time to diagnosis averaged 18.23 days, and the time to treatment averaged an additional 20.03 days. "This team approach to fighting the disease led to thorough and timely evaluation, treatment, and follow-up," said Tuason. "With this process, we were able to get the times down to less than 3 weeks instead of the 4 months shown in the [previous] studies. We truly believe that the earlier you diagnose lung cancer and the earlier you initiate treatment, the better the outcomes will be for your patient." According to the poster, "The APN had the knowledge and expertise to add value not just in coordinating care but in clinical decision making, collaboration, education, and continuous process improvement." Tuason, who was hired as her center's lung cancer program APN, said that patients appreciate having someone who follows them through the entire process. "It's a stressful time and they know that I'm there for them, making sure their scans and tests are being read in a timely manner, researching information for their questions, or just available to talk over concerns." She added, "This is absolutely a program that can be easily adopted by other centers." Her program's new protocol for a suspicious CXR (that turns out to be lung cancer) now includes these steps:
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