No Time to Lose: Integrated Rapid Referral Pathways for Lung Cancer
Too many people across Europe are waiting too long to move from suspected lung cancer to diagnosis and treatment.
Delays can happen at every stage, from a first consultation and referral to specialist assessment, diagnostic testing and the start of treatment. Lung Cancer Europe’s new Position Statement, No Time to Lose: Integrated Rapid Referral Pathways for Lung Cancer, calls for every EU Member State to have a coordinated rapid referral pathway that connects primary, secondary and tertiary care.
The scale of the problem
Evidence from across Europe shows substantial differences in how quickly people move through lung cancer care.
In Spain, people waited a median of 69 days from the first onset of symptoms to entering the lung cancer care pathway. In the Netherlands, only 66% received a definitive diagnosis within five weeks. In Bulgaria, waiting times between diagnosis and treatment varied considerably depending on treatment and location, while in the UK average waits for surgery ranged from 83 to 97 days.
Lung Cancer Europe’s own research has found similar problems. In our 2022 survey, more than a quarter of respondents waited more than one month between their first medical consultation and seeing a lung specialist, while 43.2% did not start treatment within one month of diagnosis.
These delays can mean disease progression, fewer treatment options and poorer outcomes.
Faster pathways can work
There is also evidence that changing the way people move through the system can reduce delays.
Rapid referral approaches have already produced results in several European countries:
In Ireland, referral to first appointment times fell from 43.5 days to 21 days.
In Norway, the proportion of people diagnosed with metastatic lung cancer fell from 52% to 45%.
In Denmark, the time between first referral and treatment initiation fell from 56 days to 42 days.
In Manchester in the UK, the RAPID programme substantially increased the proportion of people with suspected lung cancer receiving their first CT scan within three days, seven days and two weeks.
What is an integrated rapid referral pathway?
An integrated rapid referral pathway is designed to help people with suspected lung cancer move through assessment, diagnosis and treatment as quickly and efficiently as possible.
This can include priority referrals from primary care, dedicated specialist clinics, rapid access to imaging and diagnostic tests, clear waiting-time targets, coordination between different parts of the healthcare system, and electronic systems that track progress through the pathway.
What Lung Cancer Europe is calling for
The Position Statement, led by Lung Cancer Europe EU Policy and Engagement Manager Michaela Regan, sets out five recommendations:
1. Involve GPs from the beginning
GPs should be involved in the design and implementation of urgent referral pathways, with the training, tools and resources needed to identify and refer people with suspected lung cancer quickly.
2. Establish specialist fast-track clinics
Healthcare systems should provide dedicated referral routes with rapid access to multidisciplinary specialists, imaging, bronchoscopy, pathology, molecular testing and treatment.
3. Implement lung cancer screening across Europe
All EU Member States should provide equitable access to low-dose CT screening for eligible high-risk populations.
4. Integrate patient-reported outcomes throughout the pathway
Information about symptoms, quality of life, functional status and support needs should be routinely collected and used as part of care.
5. Improve data infrastructure and quality monitoring
Countries should monitor and publicly report waiting times, identify bottlenecks and use pathway data to plan workforce and diagnostic capacity.
Healthcare systems across Europe are different, so rapid referral pathways will not look identical in every country. But the principle is the same: people with suspected lung cancer should not face avoidable delays because different parts of the healthcare system are not properly connected.