Delays in lung cancer management pathways between rural and urban patients in North Queensland: a mixed methods study

INTRODUCTION: Aims of this study were to examine time delays in lung cancer referral pathways in North Queensland (NQ), Australia, and explore patients' perspective of factors causing these delays. METHODS: Prospective study of patients attending three cancer centres in Townsville, Cairns and Mackay in NQ from 2009 to 2012. Times along referral pathway were divided as follows: Onset of symptoms to treatment (T1), symptoms to general practitioner(GP) (T2), GP to specialist (T3), and Specialist to treatment (T4). Quantitative and qualitative methods were used for analysis. RESULTS: 252 patients participated. T1 was influenced by remoteness (125 days in Townsville vs. 170 days for Remote, p=0.01), T2 by level of education (91 days for Primary education vs. 61 days for Secondary vs. 23 days for Tertiary/TAFE, p=0.006), and age group (14 days for 31-50 years, 61 days for 51-70 years, 45 days for >71 years, p=0.026), T3 by remoteness (15 days for Townville and 29.5 days for remote, p=0.02) and T4 by stage of disease (21 days for stage I, 11 days for Stage II, 34 days for Stage III 18 days for Stage IV, p=0.041). Competing priorities of family and work and cost & inconvenience of travel were perceived as rural barriers. CONCLUSION: Remoteness, age and level of education were related to delays in various time lines in lung cancer referral pathways in NQ. Provision of specialist services closer to home may decrease delays by alleviating burden of cost and inconvenience of travel.