Table 1

Established indications for cancer-related diagnostic work-up and defined time periods

Colorectal cancerTime to initiate diagnostic evaluationLung cancerTime to initiate diagnostic evaluation*
Confirmed iron deficiency anaemia7 daysBlood in sputum/haemoptysis7 days
Screen positive for faecal occult blood test7 daysHoarseness that lasts more than 2 weeks7 days
Screen positive for barium enema7 daysRecurrent bronchitis or pneumonia7 days
Abnormal imaging suspicious for colorectal cancer7 daysAbnormal chest x-ray7 days
Haematochezia in the absence of negative colonoscopy within previous 1 year7 daysAbnormal chest CT scan7 days
Suspected rectal or abdominal mass on physical exam7 daysAbnormal abdomen CT scan7 days
Change in bowel habit60 daysSerial abnormal imaging7 days
Due for endoscopic surveillance based on previous test90 daysAbnormal sputum examination/sputum cytology7 days
Obstruction7 daysUnexplained effusion7 days
Microcytic anaemia30 daysClubbing7 days
New onset Cushing's symptoms/syndrome7 days
New onset of hypercalcaemia symptoms/syndrome7 days
New onset of syndrome of inappropriate antidiuretic hormone secretion7 days
Superior vena cava obstruction7 days
Worsening persistent cough/bronchitis OR new description of chronic cough lasting >8 weeks7 days
Provider acknowledged unexplained weight loss or other unexplained weight loss >10 lbs in addition to respiratory symptoms7 days
  • * We also tested a more lenient criteria of 14 days for appropriate diagnostic evaluation (rather than 7 days), but it did not substantially reduce the number of missed opportunities.41