The Impact of Diagnostic Imaging Wait Times on the Prognosis of Lung Cancer

Byrne, Suzanne C.; Barrett, Brendan; Bhatia, Rick

doi:10.1016/j.carj.2014.01.003

Cited by 29 publications

(19 citation statements)

References 7 publications

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“…Delays in beginning therapy for lung cancer may result in disease progression and death [4, 24–27]. In one small study of patients with stage III cancers slated for definitive radiotherapy, treatment intent changed from curative to palliative in 29% owing to cancer progression in less than 30 days [25].…”

Section: Commentmentioning

confidence: 99%

“…Stage progression is associated with decreased surgical cure rates and poorer overall survival [2]. Delays in the diagnosis and treatment of lung nodules are common [3, 4], and the timely care of lung nodules suspicious for cancer is presumed critical for individual patients and population health [5, 6]. Researchers have examined the impact of delays in lung cancer resection for more than 2 decades [7] We know that, as a group, patients with larger tumors do worse than patients with smaller tumors [8].…”

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confidence: 99%

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Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?

Maiga

Deppen

Pinkerman

et al. 2017

The Annals of Thoracic Surgery

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Background Timely care of lung cancer is presumed critical, yet clear evidence of stage progression with delays in care is lacking. We investigated the reasons for delays in treatment and the impact these delays have on tumor-stage progression. Methods We queried our retrospective database of 265 veterans who underwent cancer resection from 2005 to 2015. We extracted time intervals between nodule identification, diagnosis, and surgical resection; changes in nodule radiographic size over time; final pathologic staging; and reasons for delays in care. Pearson’s correlation and Fisher’s exact test were used to compare cancer growth and stage by time to treatment. Results Median time from referral to surgical evaluation was 11 days (interquartile range, 8 to 17). Median time from identification to therapeutic resection was 98 days (interquartile range, 66 to 139), and from diagnosis to resection, 53 days (interquartile range, 35 to 77). Sixty-eight patients (26%) were diagnosed at resection; the remainder had preoperative tissue diagnoses. No significant correlation existed between tumor growth and time between nodule identification and resection, or between tumor growth and time between diagnosis and resection. Among 197 patients with preoperative diagnoses, 42% (83) had intervals longer than 60 days between diagnosis and resection. Most common reasons for delay were cardiac clearance, staging, and smoking cessation. Larger nodules had fewer days between identification and resection (p = 0.03). Conclusions Evaluation, staging, and smoking cessation drive resection delays. The lack of association between tumor growth and time to treatment suggests other clinical or biological factors, not time alone, underlie growth risk. Until these factors are identified, delays to diagnosis and treatment should be minimized.

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Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?

Maiga

Deppen

Pinkerman

et al. 2017

The Annals of Thoracic Surgery

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“…However, the effect of timely investigation and treatment for lung cancer on progression-free survival (pfs), relapse-free survival (rfs) after primary surgical resection, and overall survival (os) is unclear 10,11 . Delays in patient flow through diagnostic imaging and biopsy, and prolonged times from diagnosis to radical radiotherapy have been reported by some authors to result in an increase in tumour size and stage 12,13 . Others have reported no association between time to diagnosis or treatment and clinical outcomes 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Wait Times for Diagnosis and Treatment of Lung Cancer: A Single-Centre Experience

et al. 2017

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“…Byrne and co-workers report the change in stage between first abnormal imaging and CT-guided biopsy for 66 patients. 34 Over a median of 81 days, 17 patients progressed one stage, 5 progressed two stages and 1 progressed three stages. We assumed that patients receiving a false negative diagnosis would present 104 days later at an emergency department, at which point the proportion of patients progressing one or more stages would be as reported in Byrne et al where progression indicated stage beyond IV patients were assumed to remain at stage IV.…”

Section: Data Sourcesmentioning

confidence: 99%

Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

Bajre¹,

Pennington

Woznitza

et al. 2017

Radiography

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Please cite this publication as follows:Bajre, M., Pennington, M., Woznitza, N., Beardmore, C., Radhakrishnan, M., Harris, R. and Mccrone, P. (2017) Expanding the role of radiographers in reporting suspected lung cancer: a cost-effectiveness analysis using a decision tree model. Radiography, 23 (4 IntroductionTo assess whether an enhanced role for radiographers in reporting lung cancer chest radiographs is cost-effective. MethodsCosts and outcomes of chest radiograph reporting by reporting radiographer or by a radiologist were compared using a decision tree model. The model followed patients from an initial chest radiographs for suspected lung cancer to the provision of cancer care in positive cases. Sensitivity and specificity of reporting for radiographers and radiologists were derived from a recent trial. Treatment costs and quality adjusted life expectancy were estimated over five years for those diagnosed. Deterministic and probabilistic sensitivity analyses were used to test the robustness of inference to parameter uncertainty. ResultsFor 1,000 simulated patients, radiographer reporting decreased detection costs by £8,500 and detected 10.3 more cases at initial presentation. After including treatment costs and outcomes, radiographer reporting remained cheaper than radiologist reporting and resulted in 1.4 additional QALYs per 1,000 screened patients. Probabilistic analysis indicated a 98% likelihood that radiographer reporting is cheaper and more effective than radiologist reporting after inclusion of treatment costs and outcomes. ConclusionRadiographer reporting is a cost-effective alternative to radiologist reporting in lung cancer diagnosis. Further work is needed to support the adoption of radiographer's reporting pathway in diagnosis of lung cancer suspected patients.Word count -2483

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The Impact of Diagnostic Imaging Wait Times on the Prognosis of Lung Cancer

Cited by 29 publications

References 7 publications

Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?

Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?

Wait Times for Diagnosis and Treatment of Lung Cancer: A Single-Centre Experience

Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model

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