Diagnosis Program Improves Time to Biopsy in Emergency Department, Primary Care Clinic

An accelerated diagnostic assessment program (ADAP) was initiated to improve wait times for a diagnostic work-up in which a cancer diagnosis is suspected, with or without concomitant symptoms, in patients who were primarily examined by primary care practitioners or emergency departments (EDs), where access to cancer work-up is limited.

The ADAP was developed and led by oncologists to shorten the time from external referral to tissue biopsy in a Canadian tertiary setting and a control group that was made up of similar patients who had not been referred by the ADAP. The primary objective was time to biopsy and results were evaluated using 1-way analysis of variance and 2-tailed independent t tests.

A total of 97 patients enrolled in the ADAP cohort and the mean age was 65.8 years (range, 18-96); men and women were equally enrolled. The control cohort had similar ages, biopsy sites, and referral source characteristics as the treatment group.

The investigators found that improvement in time to the histologic diagnosis of cancers and time to treatment initiation in patients could be accomplished with the ADAP approach. By streamlining diagnostic work-ups to minimize wait times, especially in patients with imaging abnormalities suggestive of cancer who require urgent specialist care, time to biopsy can be improved.

Investigators evaluated key services, and the associated wait times at the ADAP were outlined for all biopsies, including biopsies that were eventually diagnosed as malignant and for biopsy-site matched ADAP and control cohorts. Patients in the ADAP program had a faster time to biopsy (P < .001) with a mean of 17.6 days (n = 43) compared with the tertiary hospital’s standard pathway.

Cancer Care Ontario, the government’s principal cancer advisory entity, shares guidelines and standards with health care providers in the community. The agency recommends that the wait time between referral and oncology specialist appointments should be under 14 days; the ADAP averaged just over 9 days between referral and consultation.

Similarly, according to current guidelines, in 90% of patients diagnosed with breast cancer, abnormal screening results be addressed within 7 weeks, if a tissue biopsy is required. For patients in the ADAP, the referral to resolution was just over 4 weeks.

Investigators noted 2 potential limitations for the study. First, the control group was selected during the same time interval as the ADAP group, which could potentially introduce selection bias on the basis of referral pathways. However, patients in both groups were referred by primary care physician clinics and EDs when the program was in its pilot phase and before a standardized process was implemented in the region.

Second, researchers reported that because of the low number of biopsy sites other than lymph nodes, liver, and abdominal masses, they could not comprehensively evaluate the primary end point for all patients in the ADAP with a malignancy. Diagnostic outcome was not available for the control arm; thus, they could not conduct time-to-treatment, survival rate, and symptom burden comparisons.

The researchers concluded that the improved time to biopsy, and outperformance compared with national and provincial standards, demonstrated the efficacy of the initiative. The program addressed a gap in care by delivering access to diagnosis and treatment in an underserved population.

REFERENCE

Bourkas AN, Menard A, Tarulli E, Jodoin L, Biagi JJ. Impact of an accelerated diagnostic assessment program on the timeliness of cancer diagnosis and treatment. JCO Oncol Pract. 2023;OP2200551. doi:10.1200/OP.22.00551