Impact of an Onsite Endobronchial Ultrasound Program on the Time to Treatment of Cancer in Veterans.

Abstract

Background Endobronchial ultrasound (EBUS) is commonly employed in the diagnostic evaluation of pulmonary nodules and for mediastinal staging of lung cancer. We hypothesized that the establishment of an onsite EBUS program would decrease the time to the diagnosis and treatment of detected malignancy in veterans seen in a dedicated pulmonary nodule clinic. Methods We conducted a retrospective chart review of patients seen at the Baltimore Veterans Affairs Medical Center (BVAMC) pulmonary nodule clinic and required diagnostic evaluation. One hundred and fifty consecutive patients before and after implementation of an onsite EBUS program were screened. Results Forty-nine patients from the pre-intervention group and 41 patients from the post-intervention group underwent diagnostic evaluation and were included in study analyses. There was no significant difference in the median number of days between CT chest and initial visit to the BVAMC Lung Mass Clinic (22 vs. 14 days, P = 0.06), CT chest to diagnostic procedure (47.5 vs. 37 days, P = 0.33), and CT chest to initial treatment of detected malignancy (103 vs. 88 days, P = 0.15). There was no significant difference in the lung cancer stages or 1-year mortality between groups. A total of 76 barriers to care were identified among the 90 patients. Conclusions There was a trend towards improving the time from the initial CT chest to the treatment of cancer with onsite availability of EBUS. More efforts need to be done to decrease the modifiable barriers to treatment to improve the overall lung cancer care for veterans.