1405 - Quality indicators and non small cell lung cancer integrated care pathway: a single-center experience

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Supportive Measures
Thoracic Malignancies
Presenter Jessica Menis
Authors J. Menis1, A. Follador2, F. Valent3, C. Rossetto4, M. Gaiardo4, L. Gurrieri4, E. Lugatti5, S. Pizzolitto6, V. Tozzi7, G. Fasola4
  • 1Medical Department, University Hospital Santa Maria della Misericordia, 33100 - Udine/IT
  • 2Oncologia, University Hospital Santa Maria della Misericordia, 33100 - Udine/IT
  • 3Statistics, Friuli Venezia Giulia, 33100 - Udine/IT
  • 4Department Of Medical Oncology, University Hospital Santa Maria della Misericordia, 33100 - Udine/IT
  • 5Chest Medicine, University Hospital Santa Maria della Misericordia, 33100 - Udine/IT
  • 6Pathology, University Hospital Santa Maria della Misericordia, 33100 - Udine/IT
  • 7Icp Research Responsible, University Bocconi, Milan/IT



Non Small Cell Lung Cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated Care Pathways (ICP) might be a good strategy to overview and improve patient's management. The aim of our study was to review our NSCLC patient's ICP in order to provide evidence of clinical or organizational inappropriateness.


We retrospectively reviewed the electronic medical records of 169 NSCLC patients who had had a first access at the Oncology Department of the University Hospital Santa Maria della Misericordia (Udine, Italy) during 2010. The ICP mapping and few quality indicators had already been settled by a previous study on the 2008 population and were integrated with new uptodate indicators selected from scientific literature and discussed at the weekly MDT.


146 patients were considered eligible; median age was 67 years old. Patients were mainly males (65%), had adenocarcinoma histology and advanced disease at the time of diagnosis (52.7%). Distant from benchmark were the percentage of diagnostic bronchoscopic procedures (60.7 vs 80-85%), the number of surgical candidates who underwent mediastinoscopy for positive PET for mediastinal nodes (0 vs 100%), median time from diagnosis to surgery and to chemotherapy (58.5 vs 21 and 34 vs 21 days; p < 0.0001) and median time from PET to surgery (53.5 vs 14 days; p < 0.0001). No extemporary citology during bronchoscopy was performed and only 42.8% of the patients received concomitant chemo-radiotherapy for stage III disease. Stage was the only indipendent variable associated with shorter time from first chest physician examination to diagnosis (p = 0.028) and from diagnosis to the first chemotherapy administration (p < 0.0001).


Our analysis has highlighted a good adherence to current national and intenational guidelines and scientific literature as far as medical oncology treatment and pathological diagnosis are concerned. There is still room for improvement, most of all regarding the pre-surgical procedures and timing for surgery. The ICP study has proven to be a feasible ad efficacious methodology to point out the patient's health management.


All authors have declared no conflicts of interest.