Predicting delays in lung cancer diagnosis and staging

Abstract

BackgroundDespite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions.MethodsWe analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded.ResultsMalignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03).ConclusionsA greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.

Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis

“…The concept of barriers to quality care (such as the receipt of timely and appropriate diagnostic, staging and treatment selection) is used in the context of improving health care management or prevention programs [ 7 ]. In our study, clinicians placed greater emphasis on some factors that prevent rapid referral to specialty such as poor communication between services and referral network, and patients low socioeconomic/cultural levels.…”

“…Most cases of lung cancer (around 60–70%) are diagnosed in symptomatic patients that are usually at an advanced stage of the disease, which means a poorer prognosis and limited treatment [ 7 ]. If the diagnosis is performed in early stages of the disease, allowing for more immediate treatments, survival with curative-intent surgery rates can vary between 60% to 80% [ 2 , 8 ].…”

Diagnostic delay in lung cancer in Morocco: A 4-year retrospective study

“…4 Lung cancer is often diagnosed in symptomatic patients. 5 The core symptoms of lung cancer include cough, dyspnea, chest pain, fatigue, hemoptysis, and weight loss. 6 Those symptoms are very common in general practice, it would be difficult to distinguish them from the symptoms of other respiratory diseases.…”

“…In the literature, several studies have focused on the study of diagnosis delays of patients with lung cancer. [5][6][7][8] Some countries have implemented guidelines for the optimal timing of diagnosis and treatment of lung cancer. 9 The British Thoracic Society (BTS) has made various recommendations concerning the diagnosis and treatment delays for patients with lung cancer.…”

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

“…The prompt diagnosis and staging of NSCLC provides vital information on the anatomical details and extent of cancer with respect to the size of the primary tumor, lymph nodal status, and the presence or absence of metastasis in distant organs, which can guide more assertive therapeutic decisions [ 30 , 31 ]. The National Comprehensive Cancer Network and European Society of Medical Oncology recommend an intravenous contrast agent-enhanced chest CT, 18-fluorodeoxyglucose ([18F]-FDG)-PET-CT and, depending on the guidelines, a brain MRI for staging of NSCLC before treatment with curative intent [ 32 , 33 , 34 ].…”