Longitudinal outcomes in pre-treatment lung cancer management: A retrospective observational study of the Victorian Lung Cancer Registry.

Lung cancer is the leading cancer burden and the leading contributor to lung cancer mortality. The use of a Clinical Quality Registry (CQR) is an opportunity to identify unwarranted variation in lung cancer management from clinical practice guidelines and to identify unwarranted geographical variation in outcomes. The VLCR was established in 2011 and now captures data on >2,500 (>85%) of new Victorian lung cancer diagnoses. Evidence of causation of CQR in quality improvement in disease management is difficult to establish. One strand of evidence of association in impact of CQR lies in observation of longitudinal change in indicator performance since registry inception. We measure a series of indicators relevant to the preoperative management of lung cancer patients including: 1. Number of patients where time from referral date to diagnosis is ≤ 28 days 2. Number of patients where time from diagnosis date to first treatment date (any intent) is ≤ 14 days 3. Number of patients with NSCLC where time from diagnosis date to surgical resection date is ≤ 14 days 4. Number of patients where time from referral date to first treatment (any intent) is ≤ 42 days 5. Number of patients with documented screening for supportive care 6. Number of patients with documented ECOG status 7. Number patients with clearly documented cTNM staging 8. Number of patients with documented presentation at a lung MDM 9. Number of patients undergoing resection with clearly documented PET scan 10. Number of patients with confirmed tissue diagnosis (malignant cytology or histology) 11. Number of patients with NSCLC (stage IV) referred to palliative care within 8 weeks of diagnosis 12. Number of patient receiving anti-cancer treatment (surgery, radiotherapy, chemotherapy, biological therapy) We sought to consider five questions: 1. Was there any evidence of change in performance measures reflecting pre-treatment management of lung cancer patients between 2014-2019? 2. Were the patterns of change consistent across the state of Victoria? 3. What, if any, were the determinants of change in performance indicators? 4. Did preoperative performance have any impact on overall receipt of treatment? 5. Did pre-operative QI performance have any impact on 1 or 2 year survival?