This workshop, held on 30 July, 2025, brought together more than 100 clinicians, nurses, administrators and consumer representatives to examine how we can better meet The Lung Cancer Optimal Care Pathway (OCP) timelines. The OCP for lung cancer was developed through a national consultation led by Cancer Australia in 2014, and updates in 2016, 2021 and 2025 (the latter for the National Lung Cancer Screening Program only).
While local solutions are emerging, a consistent message was clear: delays are common, variable, and difficult to address without better data and coordination.
A National Challenge: No State is Meeting Lung Cancer Optimal Care Pathway Timelines
The workshop opened with a brief review of state-by-state performance against the OCP timelines. With no national registry to collect and compare this data, each state currently reports slightly different outputs. Despite this variation, one message was clear: no state is currently meeting the recommended OCP timelines in at least 80% of lung cancer cases.
In all jurisdictions, time to treatment was the worst-performing metric, likely absorbing cumulative delays from earlier stages in the pathway. This means that even if one step is improved, delays in others can still have a knock-on effect.
Participants repeatedly noted that without a national clinical quality registry, it remains difficult to identify unwarranted variation, benchmark performance, or measure whether interventions are improving care.
The Patient Perspective
Session Chair, Dr Joel Rhee (GP) introduced the first speaker, consumer advocate, John Cannings, OAM, who shared a compelling patient perspective. John described how easy it is to ignore a cough when you’re a non-smoker and busy with life; both he and his GP initially did not consider lung cancer.
However, even when lung cancer is suspected at the GP appointment, meeting the OCP timelines for referral to first specialist appointment (14 days) can be challenging. John’s presentation also reminded the audience that while the timelines may seem short on paper, intervals of 14 days or longer feel incredibly drawn out for a person facing a suspected or new cancer diagnosis.
Navigating the Lung Cancer Pathway: Coordination, Delays and Diagnostic Workup
Improving referral timelines
The initial referral timelines from GP to first specialist appointment appear to be most effectively addressed through strong referral networks and enhanced coordination in the pre-diagnostic phase.
Workshop participants repeatedly highlighted the important role of specialist lung cancer nurses and care coordinators in navigating patients through investigations and appointments, helping reduce avoidable delays before diagnosis.
Optimising the diagnostic workup
Respiratory physician, Dr Andrew Pattison focused on optimising the timeframe from first suspicion to multidisciplinary team (MDT) discussion.
This ‘workup’ period often begins with PET imaging prior to biopsy, as biopsy sites may change following PET results. However, access to PET imaging remains a major source of delay in some regions.
Andrew emphasised the importance of conducting investigations in parallel wherever possible, noting that sequential testing frequently pushes patients outside the OCP timelines. He also highlighted that while additional molecular testing may continue after MDT discussion, diagnosis and staging should be complete prior to presentation to avoid repeated MDT review and additional delays.
From MDT to treatment initiation in 14 days
A/Prof Melissa Moore outlined the complexity of the period between MDT discussion and treatment commencement, where patients may require surgery, radiation therapy, systemic therapy, or supportive care across multiple sites and teams.
This stage often absorbs delays from earlier parts of the pathway. In some cases, MDT recommendations may remain dependent on final molecular testing results, further extending timelines.
The presentation highlighted that delays can occur at almost every step, including:
- Specialist availability
- Referral processes
- Molecular testing turnaround times
- Theatre and infusion capacity
- Radiation planning
- Allied health assessment
- Bed availability
Where delays occur
Across jurisdictions and settings, several recurring bottlenecks were identified:
- Delays before formal referral is lodged
- GP–specialist “phone tag”
- Limited access to PET, CT, bronchoscopy and EBUS for biopsy
- Molecular testing turnaround times of 4–6 weeks in some regions
- Patient transfers from small regional hospitals for complex diagnostics
- First specialist appointment delays and infusion capacity constraints
- Workforce shortages, particularly in medical oncology
Additionally, administrative systems also contribute to delays. Some services still rely on paper or scanned referrals, while conversely, others reported that Electronic Medical Record (EMR) workflows can slow referrals by requiring multiple processing steps before specialist review.
Practical Solutions and a Path Forward
While the workshop highlighted significant pressures across the lung cancer pathway, it also demonstrated substantial innovation and willingness to improve care. A recurring theme was that services cannot improve what they cannot consistently measure. As Australia enters the National Lung Cancer Screening Program era, participants repeatedly returned to the importance of coordinated data collection, benchmarking, and care coordination to ensure improvements in timeliness translate into better patient outcomes. Several effective local models were highlighted:
Despite these challenges, the workshop highlighted several effective local models:
- Nurse-led pre-diagnostic coordination, often delivered by lung cancer CNCs or CNSs, was repeatedly identified as one of the most effective ways to improve early timelines.
- Telehealth triage models, such as Lung TRACS, demonstrated that referral-to-first-consult targets can be met when coordination, admin support and navigation are resourced.
- Virtual MDTs and online referrals have improved attendance and access to specialist expertise in some regions.
- State initiatives such as the long-standing Victorian Lung Cancer Registry, LUCAP in WA and Queensland’s QOOL system show that once data are collected and fed back to services, change follows.
More on Lung Cancer Optimal Care Pathway Timelines
- Nash et al (2024) Lung cancer (internet-based) Delphi (LUCiD): A modified eDelphi consensus process to establish Australasian clinical quality indicators for thoracic cancer https://doi.org/10.1111/resp.14812
- Malalasekera (2021) Why do delays to diagnosis and treatment of lung cancer occur? A mixed methods study of insights from Australian clinicians. https://doi.org/10.1111/ajco.13335
- Leong et al (2025) Optimal lung cancer care pathways: a Tasmanian perspective https://doi.org/10.1071/AH24249
