The UK National Optimal Lung Cancer Pathway (NOLCP) was developed to reduce unnecessary delays for the treatment of lung cancer. The NOLCP mandates access to CT scan within 72 hours of an abnormal chest x-ray (CXR). Traditionally, CT scans were arranged by secondary care following a primary care referral. This study aims to compare the time from abnormal CXR to date of treatment decision prior to and after the implementation of a novel triage strategy that satisfies the 72 hour CT access target.

An observational study comparing time from abnormal CXR to CT and treatment decision in patients with non-small cell lung cancer (NSCLC), before and after the implementation of rapid-access CT. The patients considered had a diagnosis of NSCLC and received active treatment with curative or palliative intent and were referred from primary care. Data were retrospectively analysed over two six months periods in 2018/19 and 2021/22.

The average time from CXR to CT was less in the rapid CT cohort compared to the non-rapid CT cohort: the median time was three days compared to 15 days respectively. The time from abnormal CXR to treatment decision was similar between groups: median time of 66 days in the non-rapid CT cohort and 65 days in the rapid CT cohort.

A local initiative to reduce the time taken to CT imaging following an abnormal CXR was successful. However, there was no overall impact on the time to treatment decision. Reducing the time to CT alone is not sufficient to reduce the time to treatment decision without other delays in diagnostic and staging investigations being addressed.