BREATHING IN A NEW ERA

A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPE

Lung cancer is a race against time

T

he race against time domain addresses issues around early diagnosis and referral to treatment.

These need not only be discussed in guidelines, but specific referral pathways and timelines

should be in place. Four countries performed well in this domain: the Netherlands, Norway, Sweden

and the UK. The countries with the lowest performance were Finland and Spain. Austria and Belgium

performed better than France, Poland and Romania. Note that although the indicators in this domain

are based on policies and guidelines, many participants remarked that there can be a significant

difference between what is on paper and the actual reality—including in high performing countries

such as Sweden and the Netherlands.

Diagnosis needs to be fast-tracked...

Lung cancer is rarely diagnosed during the earliest stages of the disease, when curative treatment—

most often surgery—is an option. Early, non-specific symptoms point to a variety of other diseases and

conditions that are commonly found in primary care and so not necessarily at the front of a primary

care practitioner’s mind. Diagnosis is therefore often delayed or missed altogether.50, 51 Certainly, once a

primary care physician suspects that a patient needs to undergo diagnostic testing, it is important that

time is not wasted. Lung cancer clinical guidelines should include a fast-track for diagnostic testing.

However, this is the case in only six of our countries: Austria, Belgium, the Netherlands, Norway,

Sweden and the UK. And obtaining diagnostic testing within a specific timeframe is only discussed in

the guidelines of five countries: Austria, the Netherlands, Norway, Sweden and the UK.

Participants stressed the importance of efficient and rapid diagnostic services for any patient

suspected of having lung cancer. Some noted differences in the timing of initial suspicions of lung

cancer in patients. These variations can be regional, not simply between nations. For example, in

Sweden participants acknowledged regional variability both in the referral process and quality of care

delivered—for instance, only about a third of patients receive treatment within the 40-day timeframe

stated in the guidelines. It was said that in Austria a person suspected of having lung cancer could

receive diagnostic testing within two days in Tyrol, compared with seven days in the capital, Vienna,

and even longer in western Austria.

Even when guidelines cover diagnostic referral processes in detail, action on the ground is not always

forthcoming. However, while we acknowledge that guidelines do not guarantee the delivery of the care

described within their covers, they can establish national standards, hold providers to account and help

to alleviate regional discrepancies.

Austria Belgium Finland France Netherlands Norway Poland Romania Spain Sweden UK

Lung cancer

is a race

against time

Low Moderately Low Moderate Moderately High High