Background: Lung cancer remains the leading cause of cancer mortality despite rapid diagnostic and therapeutic advances. High-volume referral centres provide subspecialist expertise, while decentralised models support care delivery closer to home. Understanding real-world patient pathways is essential to optimise care delivery and benchmark health system performance.
Methods: We conducted a retrospective audit of all newly diagnosed lung cancer cases attending Royal Prince Alfred Hospital and/or Chris O’Brien Lifehouse between 1 July 2024 and 30 June 2025. Cases were identified across multiple electronic medical record systems. Demographics, referral patterns, diagnostic modalities, time to intervention, stage, histology, molecular profiling, and treatment delivery were collated and analysed.
Results: In 415 patients, median age was 69 years (range:31–92); 57% female; 68% current/former smokers; 4% First Nations Australians, 20% non-English speaking, 56% born overseas; and 41% residing within Sydney LHD. 43% underwent bronchoscopic biopsy versus 38% percutaneous, 17% requiring >one diagnostic and/or staging procedure. Histology comprised adenocarcinoma (71%), squamous cell carcinoma (11%), NSCLC-NOS (6%), and small cell malignancy (5%). NSCLC stage distribution was stage I (52%), II(11%), III(16%), IV(14%). 36% had an MDT discussion; 54% harboured an oncogene. Active treatment was delivered in 88%: curative-intent surgery in 54% (neoadjuvant systemic therapy 4%; adjuvant 4%). Definitive chemoradiation± immunotherapy was delivered in 7%; radiotherapy (curative or palliative) to 18% at diagnosis. For advanced disease 26% received targeted therapy 1L, 7% immunotherapy, 44% chemo-immunotherapy and 23% chemotherapy alone. 15% were clinical trial-enrolled 1L; 93% had specialist nurse access.
Conclusion: These data establish a robust pre-implementation benchmark against which the impact of the National Lung Cancer Screening Program on stage distribution, resource utilisation, care pathways, and survival outcomes can be prospectively evaluated, informing strategic service planning and system optimisation. This audit provides a comprehensive overview of lung cancer care pathways and outcomes at a major Australian tertiary referral centre.