Optimal timeframes & summary

Evidence-based guidelines, where they exist, should inform timeframes. Treatment teams need to recognise that shorter timeframes for appropriate consultations and treatment can promote a better experience for patients. Three steps in the pathway specify timeframes for care. They are designed to help patients understand the timeframes in which they can expect to be assessed and treated, and to help health services plan care delivery in accordance with expert-informed time parameters to meet the expectation of patients. These timeframes are based on expert advice from the Hodgkin and Diffuse Large B-cell Lymphomas Working Group.

Timeframes for care

Step in pathway

Care point


Presentation, initial investigations and referral

Signs and symptoms

Presenting symptoms should be promptly and clinically triaged with a health professional

Initial investigations initiated by GP

For patients who do not need a prompt referral, all investigations should be completed, and a path of action decided, within 4 weeks of first presentation

Referral to specialist

Patients should be referred to a specialist:

within 72 hours if the presence of lymphoma is highly likely

within 4 weeks if indicators of concern are absent

Diagnosis, staging and treatment planning

Diagnosis and staging

Timing of diagnostic investigations should be guided by the initial severity of symptoms

Staging should be completed within 2 weeks

Multidisciplinary meeting and treatment planning

A multidisciplinary team discussion is necessary and should be conducted before implementing treatment

A meeting may not be possible if the treatment is urgent, but the treatment plan should still be ratified


Systemic therapy

The vast majority of patients will have systemic therapy

Treatment should begin within 2 weeks of diagnosis and staging

In cases with critical organ compromise or rapid clinical progression, it may be necessary to start treatment within 24 hours of diagnosis

Seven steps of the optimal care pathway

Step 1: Prevention and early detection

Step 2: Presentation, initial investigations and referral

Step 3: Diagnosis, staging and treatment planning

Step 4: Treatment

Step 5: Care after initial treatment and recovery

Step 6: Managing recurrent or residual disease

Step 7: End-of-life care

This pathway covers Hodgkin lymphoma and DLBCL treated with curative intent, provided the patient is suitable for treatment. Histologically indolent lymphomas are not included in this pathway – these cancers are not considered curable when disseminated. Treatment is often deferred in favour of a ‘watch and wait’ approach if the patient is asymptomatic, which may last for many years, or patients may receive relatively less toxic therapy. Rarer high-grade lymphomas are also not covered. The incidence of non-Hodgkin lymphoma has increased by 50 per cent since 1982 (AIHW 2017a). DLBCL is the most common subtype of non-Hodgkin lymphoma, accounting for 30–40 per cent of all cases. Hodgkin lymphoma is significantly less common, accounting for approximately 10 per cent of all lymphomas (Lymphoma Australia 2019).