Summary

Lung cancer is the leading cause of cancer death in Canada; in Alberta, this is largely due to late-stage diagnosis.1-3 Systemic gaps, including delays in specialist referrals and limited resources in rural areas, result in poorer outcomes, with some people waiting a median of 105 days for surgery.3 4 The Alberta Thoracic Oncology Programme (ATOP) uses coordinated teams and referral innovations, including radiologist-initiated and automated referrals, to cut referral wait times (from about 24 days to under 5 days) without reducing care quality.5 Next priorities are wider automation, better diagnostic access, real-time data sharing and stronger patient supports to reduce mortality and improve survival across the province.4-7

Challenge

Lung cancer causes one of four cancer deaths in Canada.1 In Alberta, incidence of lung cancer has declined, but late-stage diagnosis means that it has remained the leading cause of cancer death.2 3

Early detection and timely treatment are vital for improving survival rates. Yet, delays to diagnosis and care persist across the system, encompassing:3

  • slow specialist referrals, especially for people in remote areas, where oncologists and diagnostic resources are scarce.3
  • inequitable access to diagnostic tools and specialists; people living in rural areas and of low income experience greater disparities in access to timely lung cancer diagnosis and treatment than people in urban areas and of high income, resulting in late-stage diagnosis.8
  • long waits for potentially curative treatment; a study found that Albertans with potentially curable non-small cell lung cancer (NSCLC) often face delays that exceed recommended care timelines (for example, a median wait of 105 days from diagnosis to treatment), underscoring a significant gap in timely intervention.4

These gaps emphasise the urgent need to make systematic improvements that will reduce delays in diagnosis and treatment, and enhance lung cancer care in Alberta.3

Solution

The Alberta Thoracic Oncology Programme (ATOP), established in 2011, is dedicated to advancing cancer care in Alberta by improving the patient experience, enhancing diagnosis and treatment outcomes, and maintaining consistent standards throughout the province.3 The programme brings together specialist teams, including thoracic surgeons, interventional pulmonologists and nurse practitioners specialising in thoracic oncology.3

What has worked well:

  • Radiologist-initiated referrals significantly speed up lung cancer diagnosis and treatment.3 People referred directly by radiologists received specialist appointments and treatment decisions about 6 days sooner on average than those with traditional referrals, with time savings ranging from 4-6 days and up to several weeks in worst cases.3 Direct referrals enable earlier specialist consultation and intervention and may lead to better treatment outcomes.3
  • Automated referral systems can help address human-resource limitations and workload-related delays.3 ATOP’s automated radiology referral system, where software flags potential malignancies on computed tomography (CT) scans and triggers referrals without human input, cut median referral times from 23.6 to 4.7 days.5 This suggests that automation may be a more efficient and effective model for rapid lung cancer referral.3

ATOP has strengthened lung cancer care through faster diagnostic pathways, streamlined referrals and coordinated patient management.3 A major achievement of ATOP-North was introducing the Diagnostic Imaging Notification process, which improved timeliness for patients suspected of lung cancer.3 This innovative approach ensures quicker access to specialist care and accelerates treatment decisions, making it an effective strategy for optimising case management.6

The Alberta Referral Program, working with rapid-access clinics in Edmonton and Calgary, acts as a key hub for assessing people with suspected lung cancer, ensuring prompt evaluations and personalised treatment plans.4 The system strengthens collaboration between primary care, radiologists and thoracic oncology specialists for timely, coordinated care.6

Next steps

ATOP will continue partnering with Alberta Health Services, the Cancer Programme Improvement and Integration Network and Cancer Control Alberta.3

Priority actions to further scale its impact:

  • strengthening referral pathways with automated systems to cut wait times5
  • expanding access to positron emission tomography (PET) scans and endobronchial ultrasound in underserved areas via mobile units or telemedicine referrals 7
  • improving coordination between specialists and primary care through real-time data sharing.6
  • providing financial and logistical support for people travelling long distances to referral centres.4

Expanding the ATOP approach to the rest of the country can significantly reduce lung cancer mortality and improve survival and quality of care across Canada.3

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References:

  1. Canadian Cancer Society. 2023. New report released by the Canadian Cancer Society reveals lung cancer death rates declining faster than any other cancer type in Canada. Available here: https://cancer.ca/en/about-us/news/2023/december/2023-lung-cancer-statistics [accessed: September 2025]
  2. Canadian Cancer Statistics Advisory Committee with the Canadian Cancer Society Statistics Canada and the Public Health Agency of Canada. 2023. Summary of projected number of cancer cases and deaths in Alberta (AB) in 2023. Toronto, ON [accessed: August 2025]
  3. All.Can Canada. 2025. Alberta Thoracic Oncology Program (ATOP). Available here: https://www.allcancanada.ca/post/alberta-thoracic-oncology-program-atop [accessed: August 2025]
  4. Kim JO, Davis F, Butts C, et al. 2016. Waiting Time Intervals for Non-small Cell Lung Cancer Diagnosis and Treatment in Alberta: Quantification of Intervals and Identification of Risk Factors Associated with Delays. Clin Oncol (R Coll Radiol) 28(12): 750-59 [accessed: August 2025]
  5. Veenstra JS, Khalid T, Stewart KC, et al. 2020. Automatic Referral for Potential Thoracic Malignant Diseases Detected on Computed Tomographic Scan. Ann Thorac Surg 110(6): 1869-73
  6. Gillson AM, Veenstra J, Stewart K, et al. 2017. Timeliness of Referrals Using a Diagnostic Imaging Notification Process for Patients Suspected of Having Lung Cancer. CHEST 152(4): A661
  7. Ramsahai JM, Molnar C, Lou L, et al. 2020. Does prior mediastinal lymph node aspiration contribute to false-positive positron emission tomography-computed tomography? ERJ Open Res: 10.1183/23120541.00103-2020:
  8. Canadian Partnership Against Cancer. 2020. Lung cancer and equity: A focus on income and geography. Available here: https://s22457.pcdn.co/wp-content/uploads/2020/11/Lung-cancer-and-equity-report-EN.pdf [accessed: September 2025]