Rapid Investigation Clinic, Quebec
- ALL.CAN CANADA
- Jun 6
- 9 min read

THEMES:
• Timely pathology
• Coordinated care
• Diagnostic services
• Navigation
• Multidisciplinary teams • Neoplasm staging
SUMMARY
Lung cancer remains the leading cause of cancer-related deaths in Canada, for both women and men.1,2
25.5% of all cancer deaths are lung cancer.3
The 5-year survival rate of lung cancer is only 19%.3,4
More than 50% of lung cancers were identified at a metastatic stage.
Quebec, in particular, faces challenges in reducing mortality due to disparities in care access and late diagnoses.5
Efforts to combat lung cancer mortality have focused on screening high-risk populations. While provinces like Quebec have implemented pilot programs, access remains limited compared to other cancer screening initiatives.6
Advances in molecular characterization and personalized medicine are paving the way for better outcomes in non-small cell lung cancer (NSCLC), the most common subtype.4 In Quebec, significant variability exists in diagnostic and treatment timelines across centers, with longer wait times in certain regions affecting outcomes.7
Complete staging requires both imaging studies (CT scan, PET scan ± brain imaging) and invasive diagnostic procedures to achieve the necessary tissue confirmation.8 Best practices for lung cancer staging emphasize the use of PET scans to detect unexpected metastatic disease and to prevent non-curative surgeries, ensuring that treatment decisions are based on accurate staging. Additionally, minimally invasive needle techniques are recommended as the first-line test for confirming mediastinal disease when lymph nodes are accessible, reducing the need for more invasive procedures. These evidence-based approaches help improve diagnostic accuracy and optimize patient outcomes in lung cancer management.8
An audit of CT chest reports9 found that guideline-aligned recommendations for the evaluation of suspected lung cancer are infrequently included in CT reports, particularly regarding both imaging studies and invasive diagnostic procedures. Integrating more evidence-based guidance into these reports could help address existing quality gaps in lung cancer diagnosis and staging, ultimately improving patient management and outcomes.
SOLUTION
As a novel model of care, the Rapid Investigation Clinic (RIC) provides a centralized and coordinated approach to the diagnosis and staging of lung cancer, ensuring timely access to imaging studies and multidisciplinary care. It prioritizes minimally invasive techniques like endobronchial ultrasound-guided needle aspiration (EBUS) for diagnosis and staging, and Positron Emission Tomography (PET) scanning for detecting metastatic disease.4
HOW IT WORKS
The Rapid Investigation Clinic (RIC) at the Montreal Chest Institute (MCI) was established in February 2010 to expedite the diagnostic process for patients with suspected lung cancer, serving as a central hub for clinical care, research, and education in respiratory diseases.
RIC Objectives:
Reduce the time between initial suspicion and diagnosis
Ensure timely initiation of treatment
Provide comprehensive support throughout the diagnostic journey
RIC Multidisciplinary Team:
7–9 pulmonologists
Dedicated clinical nurse and coordinator
Occasional participation from thoracic surgeons.
The key objectives of the RIC include accelerating the diagnostic process for suspected lung cancer cases while optimizing efficiency and ensuring adherence to clinical guidelines. The clinic also fosters close collaboration with key programs such as interventional pulmonology, the Lung Cancer Clinic (LCC), and the provincial lung cancer screening program to enhance coordination and streamline patient care.10 Treatment decisions are not made at the Rapid Investigation Clinic (RIC) in Montreal. Instead, complex diagnostic cases are presented weekly to MCI’s multidisciplinary tumor board, where specialists collaborate on evaluations. Patients are then referred to the multidisciplinary lung cancer clinic, where treatment decisions are made. The primary goal of RIC is to ensure that all necessary diagnostic and staging information is available, allowing for timely and personalized treatment planning to optimize patient outcomes.
CHALLENGES
Lung cancer investigation faces several challenges, including complex cases not reflected in standard quality indicators and an aging population with multiple comorbidities, requiring a tailored approach. A multicenter study in Quebec highlighted significant disparities in diagnostic and treatment timelines across the province. Rapid Investigation Clinics (RICs) are recommended to address these delays.7 Symptom management and psychosocial support are essential for comprehensive care but are often lacking or are not sufficient. Clinical nurses play a crucial role in ensuring continuity of care, but inefficient triage processes often delay diagnosis and treatment. Additionally, post-RIC transitions, such as referrals to the Nodule Clinic, need improvement to ensure timely follow-up. Addressing these gaps is critical to enhancing efficiency, accuracy, and patient outcomes in lung cancer care.
For years, RIC in MCI faced challenges due to the absence of an automated tracking system, requiring manual data entry and monitoring. Both MCI’s clinic and other rapid investigation centres, such as the Quebec City IUCPQ, continue to rely on labor-intensive, manual tracking and databases, which hinder efficiency and increase the risk of delays and errors in patient management.
KEY FEATURES
The Rapid Investigation Clinic (RIC) employs a centralized and coordinated approach to streamline diagnostic processes for lung cancer.11,12
The model of the RIC is based on multidisciplinary teams formed by:
respirologists
nurses
physiotherapists
respiratory therapists
nutritionists
occupational therapists
social workers
These teams work collaboratively, oversee diagnostic investigations, ensure care coordination, and provide psychosocial support to patients and families.13,14
In the case of the RIC at MCI the team consists of a limited number of respirologists with expertise in lung cancer investigation, a nurse clinician and a dedicated coordinator. There is no access to all the other expertises mentioned including respiratory therapist , social work when needed. However, the core of RIC remains:
Medical Doctor + Registered Nurse + Coordinator
Advanced tools and innovation include:
Bronchoscopic cryobiopsy and EBUS-TBNA will optimize tissue sampling and staging, which are essential for effective treatment planning.15,16
Emerging technologies, such as neural networks and biosensor-based diagnostics, show promise for:
Earlier detection
Smoother workflows17,18
Cryobiopsy is quite new at RIC at MCI/MUHC but in the process of being integrated and evaluated with the goal of obtaining better tissue for advanced molecular testing.
ACHIEVEMENTS
An institutional database was created in November 2008 for all patients with a pathological diagnosis of lung cancer, and a specialized database for RIC was started in 2010 to monitor delays. A 2017 study evaluated the impact of a Rapid Investigation Clinic (RIC) on the timeliness of lung cancer diagnosis and treatment between February 2010 and December 2011.16
During this period, a total of 195 patients within the Rapid Investigation Clinic (RIC) and 132 patients outside the RIC were compared. Findings show that guideline-concordant investigations, based on examined quality indicators, were more frequently occurring among RIC patients.
The median delay between the initial point (T0) and the first treatment was significantly shorter in the RIC at 65 days (the interquartile range, IQR 46–92 days) compared to 78 days (IQR 49–119 days) for those outside the RIC (p ≤ 0.01).
Time to pathologic diagnosis was also significantly shorter among those within the RIC at 26 days (IQR 14–42 days) than 40 days (IQR 16–68 days) for those outside the RIC.
When adjusting for relevant confounding factors, multivariate analysis revealed that being investigated in the RIC was correlated with a reduction in time to the first treatment by 24 days (95% confidence interval [CI] 12–35 days).

The study evaluated the adherence of Rapid Investigation Clinics (RICs) to clinical guidelines. Specific quality indicators were analyzed and compared between RIC and non-RIC patient groups:
Completed PET scans for stage I-II patients who underwent surgical resection.
Brain imaging before curative-intent treatment in stage III non-small cell lung cancer (NSCLC) patients and for all patients diagnosed with small cell lung cancer (SCLC).
Percentage of referrals to either multidisciplinary teams or tumor boards. This comparison aimed to evaluate the concordance with guidelines and the quality of the diagnostic investigations carried out in RIC and non-RIC settings.
It is important to recognize that the 2017 study reflects the early experience of the RIC, a time when some colleagues were still completing investigations outside the RIC, leading to certain challenges. One key issue was timely access to chest CT scans, which has since significantly improved. However, access to PET scans remained a major challenge at the time and continues to be an issue, though improvements have been made. The introduction of a dedicated lung cancer PET request form has helped streamline the process by allowing urgency classification based on clinical urgency ensuring that patients receive PET scans in a more timely and need-based manner.
Over the years, the Rapid Investigation Clinic (RIC) has seen a steady increase in referrals and patient visits, reflecting its growing role in lung cancer diagnosis. In 2022-2023, the clinic investigated 496 new patients, leading to 260 lung cancer diagnoses and 115 referrals to the Lung Cancer Clinic (LCC) for further management.

These results point to the value of centralized care models like the RIC in promoting adherence to evidence-based guidelines, which is a cornerstone for improving lung cancer outcomes.
FURTHER DEVELOPMENTS
Implementing a centralized automated tracking system in rapid investigation clinics (RICs) such as the Montreal Chest Institute and Quebec City’s IUCPQ would significantly enhance efficiency, reduce human errors, and ensure best practices in screening recommendations.
Research in Montreal demonstrated the role of primary care in mitigating late diagnoses. Improved integration of primary care and specialist services is critical to optimizing pathways.
Quebec initiated pilot Low-Dose Computed Tomography (LDCT) screening programs in 2021 targeting high-risk individuals. In the context of this lung cancer screening program, patients with suspicious findings on LDCT (Lung RADS 4) are referred to a rapid investigation clinic with access to multidisciplinary diagnostic and treatment expertise). This initiative aligns with recent efforts to improve early diagnosis and treatment options for populations at greater risk, reflecting a commitment to public health and proactive medical interventions.
Studies demonstrate the importance of providing patients detailed information about diagnosis and treatment options to reduce anxiety and foster trust. Chu et al. (2023) explored the unique psychosocial challenges faced by advanced lung cancer patients and highlighted the necessity of transparent communication during treatment. Initiatives such as the Pan-Canadian Lung Cancer Screening Network focus on collaboration and the development of screening frameworks that integrate patient-centered principles, including clear eligibility criteria and equitable access to treatment.
Research conducted in Quebec also underscores the role of effective patient-provider communication in reducing diagnostic delays and improving timely access to care.
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