Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review

Jacobsen, Margo M.; Silverstein, Sophie C.; Quinn, Michael; Waterston, Leo; Thomas, Christian A.; Benneyan, James C.; Han, Paul K. J.

doi:10.1016/j.lungcan.2017.08.011

Cited by 164 publications

(160 citation statements)

References 66 publications

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“…Few published recommendations exist on benchmarks for the timing of diagnostic testing after a positive lung cancer screen, and there is high variability in the definition of wait intervals used in the current literature . The RAND Corporation recommended diagnostic confirmation within 60 days of presentation .…”

Section: Resultsmentioning

confidence: 99%

“…There are several challenges of observational studies, principally confounding by indication, as defined previously, from prioritizing the follow‐up of patients who have high‐suspicion screening results or concurrent symptoms. Consequently, observational studies may show a null or reverse association between time to diagnostic testing and cancer outcomes, especially during the early phases of follow‐up, as reported in many studies . For instance, in one study of screening mammograms, the higher the level of suspicion for cancer, the shorter interval to diagnostic testing (31 days for high suspicion vs 47 days for other; P < .0001); thus women with a higher likelihood of cancer on mammograms were worked up more quickly .…”

Section: Gaps In the Evidence Of Time To Diagnostic Testingmentioning

confidence: 98%

“…31 Few published recommendations exist on benchmarks for the timing of diagnostic testing after a positive lung cancer screen, and there is high variability in the definition of wait intervals used in the current literature. 112 The RAND Corporation recommended diagnostic confirmation within 60 days of presentation. 62 The American College of Chest Physicians recommended "timely and efficient" delivery for patients with suspected or known lung cancer 113 and emphasized consideration for competing needs for resources to set local performance metrics.…”

Section: Lung Cancermentioning

confidence: 99%

“…Consequently, observational studies may show a null or reverse association between time to diagnostic testing and cancer outcomes, especially during the early phases of follow-up, as reported in many studies. 39,49,58,67,68,112 For instance, in one study of screening mammograms, the higher the level of suspicion for cancer, the shorter interval to diagnostic testing (31 days for high suspicion vs 47 days for other; P < .0001); thus women with a higher likelihood of cancer on mammograms were worked up more quickly. 49 Both Myrdal et al and Annakkaya et al reported that a longer delay from symptom to treatment initiation was correlated with a better prognosis for NSCLC.…”

Section: Gaps In the Evidence Of Time To Diagnostic Testingmentioning

confidence: 99%

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Timely follow‐up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium

Doubeni

Gabler

Wheeler

et al. 2018

CA A Cancer J Clinicians

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Timely follow-up for positive cancer screening results remains suboptimal, and the evidence base to inform decisions on optimizing the timeliness of diagnostic testing is unclear. This systematic review evaluated published studies regarding time to follow-up after a positive screening for breast, cervical, colorectal, and lung cancers. The quality of available evidence was very low or low across cancers, with potential attenuated or reversed associations from confounding by indication in most studies. Overall, evidence suggested that the risk for poorer cancer outcomes rises with longer wait times that vary within and across cancer types, which supports performing diagnostic testing as soon as feasible after the positive result, but evidence for specific time targets is limited. Within these limitations, we provide our opinion on cancer-specific recommendations for times to follow-up and how existing guidelines relate to the current evidence. Thresholds set should consider patient worry, potential for loss to follow-up with prolonged wait times, and available resources. Research is needed to better guide the timeliness of diagnostic follow-up, including considerations for patient preferences and existing barriers, while addressing methodological weaknesses. Research is also needed to identify effective interventions for reducing wait times for diagnostic testing, particularly in underserved or low-resource settings. CA Cancer J Clin 2018;68:199-216. © 2018 American Cancer Society.

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Section: Resultsmentioning

confidence: 99%

Section: Gaps In the Evidence Of Time To Diagnostic Testingmentioning

confidence: 98%

Section: Lung Cancermentioning

confidence: 99%

Section: Gaps In the Evidence Of Time To Diagnostic Testingmentioning

confidence: 99%

See 2 more Smart Citations

Timely follow‐up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium

Doubeni

Gabler

Wheeler

et al. 2018

CA A Cancer J Clinicians

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“…Rapid LC diagnostic units have proven to be very useful, although audits are necessary to evaluate them. 11,26,[30][31][32] In some series, a specific rapid diagnosis program has reduced the delay from 128 to 20 days for the entire management process and significantly reduced the delays to access a specialist or undergo a scan, a bronchoscopy, or PET-CT. 17 Nurse navigation has also improved the time from suspicion of LC to treatment with a trend toward diagnosing non-small cell lung cancer at an earlier stage, both in our study and in previous series. 33 Based on our results, we suggest some areas for improvement.…”

Section: Discussionmentioning

confidence: 99%

Predicting delays in lung cancer diagnosis and staging

et al. 2019

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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.

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Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019

et al. 2021

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IMPORTANCE Lung cancer screening (LCS) can reduce lung cancer mortality with close follow-up and adherence to management recommendations. Little is known about factors associated with adherence to LCS in real-world practice, with data limited to case series from selected LCS programs. OBJECTIVE To analyze adherence to follow-up based on standardized follow-up recommendations in a national cohort and to identify factors associated with delayed or absent follow-up. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in Veterans Health Administration (VHA) facilities across the US. Veterans were screened for lung cancer between 2015 to 2019 with sufficient follow-up time to receive recommended evaluation. Patient-and facility-level logistic regression analyses were performed. Data were analyzed from November 26, 2019, to December 16, 2020. MAIN OUTCOMES AND MEASURESReceipt of the recommended next step after initial LCS according to Lung CT Screening Reporting & Data System (Lung-RADS) category, as captured in VHA or Medicare claims. RESULTS Of 28 294 veterans (26 835 [94.8%] men; 21 969 individuals [77.6%] were White; mean [SD] age, 65.2 [5.5] years) who had an initial LCS examination, 17 863 veterans (63.1%) underwent recommended follow-up within the expected timeframe, whereas 3696 veterans (13.1%) underwent late evaluation, and 4439 veterans (15.7%) had no apparent evaluation. Facility-level differences were associated with 9.2% of the observed variation in rates of late or absent evaluation. In multivariable-adjusted models, Black veterans (odds ratio [OR], 1.19 [95% CI, 1.10-1.29]), veterans with posttraumatic stress disorder (OR, 1.13 [95% CI, 1.03-1.23]), veterans with substance use disorders (OR, 1.11 [95% CI, 1.01-1.22]), veterans with lower income (OR, 0.88 [95% CI, 0.79-0.98]),and those living at a greater distance from a VHA facility (OR, 1.06 [95% CI, 1.02-1.10]) were more likely to experience delayed or no follow-up; veterans with higher risk findings (Lung-RADS category 4 vs Lung-RADS category 1: OR, 0.35 [95% CI, 0.28-0.43]) and those screened in high LCS volume facilities (OR, 0.38 [95% CI, 0.21-0.67]) or academic facilities (OR, 0.86 [95% CI, 0.80-0.92]) were less likely to experience delayed or no follow-up. In sensitivity analyses, varying how stringently adherence was defined, expected evaluation ranged from 14 486 veterans (49.7%) under stringent definitions to 20 578 veterans (78.8%) under liberal definitions. CONCLUSIONS AND RELEVANCEIn this cohort study that captured follow-up care from the integrated VHA health care system and Medicare, less than two-thirds of patients received timely recommended follow-up after initial LCS, with higher risk of delayed or absent follow-up among marginalized populations, such as Black individuals, individuals with mental health disorders, and individuals with low income, that have long experienced disparities in lung cancer outcomes. Future (continued)

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Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review

Cited by 164 publications

References 66 publications

Timely follow‐up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium

Timely follow‐up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium

Predicting delays in lung cancer diagnosis and staging

Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019

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