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 |
Timeframe |
|
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 |
|
|
Treatment |
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).
