Length of time it takes to treat patient with lung cancer may be fatal

Editor - It is estimated that most patients who have the symptoms of lung cancer do not present to their local general practitioner or emergency department until 12-24 weeks after the onset of their symptoms. If lung cancer is suspected, referral to a chest physician takes about two weeks. If special tests are needed, a chest radiograph and spirometry will be carried out, followed by bronchoscopy and biopsy to confirm the diagnosis of lung cancer. It then takes six weeks in a typical NHS trust to attain the results of the biopsy. If computed tomography is required, the patient may have to wait for another six weeks. Once the scan has been done, the patients management will be discussed in a meeting.

The three main options for a patient with lung cancer depend on their fitness for surgery, which is assessed by using the World Health Organizations criteria for grading patient performance status, and on the TNM staging for the tumour.

These are the options for management:

(1)Palliative care—patient is not fit for surgery owing to extensive spread of tumour and metastases

(2)Patient is fit for surgery—tumour is resectable, surgery may be curative

(3)Patient is not viable for surgery at the moment—radio/chemotherapy is an option, with a view to future surgery if there is improvement and reduction in tumour size.

Approximately one in 10 patients are potential candidates for surgery. But the waiting time for surgery can be anything up to 10 weeks. These are patients whose life expectancy can increase if they have an operation as soon as possible. So why is there only one hospital in the region with a unit for thoracic surgery?

Patients who need chemotherapy first can still potentially benefit if they are seen quickly. But again the waiting times are almost 10 weeks.

The average life expectancy of a patient with small cell lung cancer at the time of presentation is 12-15 weeks. Yet, the average “journey” time for a lung cancer patient is approximately 24 weeks. Why is this?

One explanation is that NHS resources are very strained. But maybe it is not the amount of money being put into the NHS but the way money is distributed.

As tomorrows doctors we must be aware of the time it takes for a patient to receive treatment for any condition—it may well be the difference between life and death. The management of the patient continues after the initial referral, and government statistics seem to neglect this fact.