title: The pathway study: results of a pilot feasibility study in patients suspected of having lung carcinoma investigated in a conventional chest clinic setting compared to a centralised two-stop pathway.
abstract: The best chance of cure in non-small cell lung cancer (NSCLC) is surgical resection, but UK rates of 8% compare poorly to 25% in the USA and Europe. Delays in diagnosis in the current UK system may be one reason for such discrepancy. To address this problem we set up a rapid diagnostic system and compared it to the conventional method of investigations in a pilot randomised trial.
  
  
  METHODS
  Eighty-eight patients were prospectively enrolled from three District General Hospitals and randomised to either investigation locally or to the rapid system at The Royal Marsden Hospital. The pilot end-points were feasibility and audit of radical treatment rates to enable estimates for patient numbers for the full study.
  
  
  RESULTS
  Forty-five and 43 patients were in the central and conventional arms, respectively (65% male, median age 69 years). There was a 4-week improvement in time to first treatment in those in the central arm (P=0.0025) with 13/30 (43%) and 9/27 (33%) patients having radical treatment in the central and conventional arms, respectively. Patients in the conventional arm felt the diagnostic process was too slow (P=0.02) while those in the central arm seemed to have a better care experience (P=0.01). There were significantly less visits to the general practitioner (GP) in the central arm (P=0.02).
  
  
  CONCLUSIONS
  This pilot study demonstrates that the full study is feasible but would require the commitment and involvement of a large number of patients and physicians. The results show several advantages to investigations and diagnosis in the central arm, particularly in time to treatment initiation, patient satisfaction and rate of radical treatments. The improved rate of radical treatment could lead to an improved survival rate.
authors.affiliation: Lung Unit, Department of Medicine, Sutton & Kent Cancer Centre, The Royal Marsden Hospital, Maidstone, Downs Road, Sutton, Surrey SM2 5PT, UK.
authors.forename: P V
authors.initials: PV
authors.lastname: Murray
authors.forename: M E R
authors.initials: ME
authors.lastname: O'Brien
authors.forename: R
authors.initials: R
authors.lastname: Sayer
authors.forename: N
authors.initials: N
authors.lastname: Cooke
authors.forename: G
authors.initials: G
authors.lastname: Knowles
authors.forename: A C
authors.initials: AC
authors.lastname: Miller
authors.forename: V
authors.initials: V
authors.lastname: Varney
authors.forename: N P
authors.initials: NP
authors.lastname: Rowell
authors.forename: A R
authors.initials: AR
authors.lastname: Padhani
authors.forename: D
authors.initials: D
authors.lastname: MacVicar
authors.forename: A
authors.initials: A
authors.lastname: Norton
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: I E
authors.initials: IE
authors.lastname: Smith
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003948:Diagnostic Techniques, Respiratory System; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D016019:Survival Analysis; D015996:Survival Rate