Wait times in the management of non–small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis

Abstract

Background: Timeliness can have a substantial effect on treatment outcomes, prognosis and quality of life for patients with lung cancer. We sought to evaluate changes in wait times for patients with non–small cell lung carcinoma (NSCLC) and to identify bottlenecks in cancer care. Methods: We included patients who received treatment with curative intent or palliative treatment for NSCLC, diagnosed through mediastinal staging by a thoracic surgeon. Data were collected from 3 cohorts over 3 time periods: before the regionalization of lung cancer care (2005–2007, C1), immediately postregionalization (2011–2013, C2) and 5 years after regionalization (2016–2017, C3). Total wait time and delays along treatment pathways were compared across cohorts using multivariate Cox proportionality models. Results: Our total sample size was 299 patients. Overall, there was no significant difference in total wait time among the 3 cohorts. However, wait time from symptom onset to first physician visit significantly increased in C3 compared with C2 (hazard ratio [HR] 0.41, p < 0.01) and C1 (HR 0.43, p < 0.01). Time from first physician visit to computed tomography (CT) scan significantly decreased in C3 compared with C2 (HR 1.54, p < 0.01). Time from abnormal CT scan to first surgeon visit also significantly decreased in C2 (HR 1.43, p < 0.01) and C3 (HR 4.47, p < 0.01) compared with C1, and between C3 and C2 (HR 2.67, p < 0.01). In contrast, time from first surgeon visit to completion of staging significantly increased in C2 (HR 0.36, p < 0.01) and C3 (HR 0.24, p < 0.01) compared with C1, as well as between C3 and C2 (HR 0.60, p < 0.01). Time to first treatment after completion of staging was significantly shorter for C3 than C1 (HR 1.58, p < 0.01). Conclusion: Trends toward a reduction in wait time are evident 5 years after the regionalization of lung cancer care, primarily led by shorter wait times for CT scans and thoracic surgeon consults. However, wait times can further be reduced by addressing delays in staging completion and patient and provider education to identify the early signs of NSCLC.

Observation on the Effect of High-Quality Nursing Intervention plus Health Education in Chemotherapy for Non-Small Cell Lung Cancer and Its Influence on the Physical and Mental Health of Patients

“…The main purpose of chemotherapy nursing was to alleviate adverse reactions, such as gastrointestinal reactions and renal toxicity, that are prone to occur during chemotherapy. At the same time, special care was given to patients with symptoms such as thrombocytopenia and leukopenia, and various nursing measures were strengthened to improve the quality of life of patients and to boost the chemotherapy effect [ 27 ].…”

“…e number of patients in the observation group with complete and partial compliance (31, 36) was substantially greater than that in the routine group (20,27), although the number of non-compliant patients (1) was signi cantly smaller than that in the routine group (11). Moreover, the total compliance rate of the patients in the observation group (98.53%) was higher than that in the control group (83.82%), (P < 0.05).…”

Wait List Strategies for CT and MRI Scans

“…A total of 91 publications were identified and included in this report. Among the Canadian publications, some were from pan-Canadian groups or were relevant to Canada in general 3,8,[10][11][12][13][14][15][16][17][18] ; others were action plans, initiatives, or studies from specific provinces, including British Columbia, [19][20][21] Alberta, 6,22 Saskatchewan, 23,24 Manitoba, 25,26 Ontario, [27][28][29][30][31][32][33][34][35][36][37][38] Quebec, 39 Prince Edward Island, 16 Newfoundland, 40 Nova Scotia, 41,42 New Brunswick, 43 and Yukon. 44 Publications were also identified from Australia, 45,46 China, 47,48 the European Union, 49 France, 50,51 India, 52 Ireland, 53 Israel,…”

Time to Surgery for Patients with Esophageal Cancer Undergoing Trimodal Therapy in Ontario: A Population-Based Cross-Sectional Study

“…To our knowledge, no other study has examined the variation in TTS between TCSCs in Ontario for esophageal cancer. Shakeel and colleagues [ 15 ] compared wait times for lung cancer before, immediately after, and five years after regionalization and did not identify a significant difference in wait times between the three groups. Since the regionalization of thoracic services implemented between 2005–2011 [ 11 , 22 ], several studies have sought to identify whether regionalization is associated with fewer postoperative outcomes and improved survival [ 12 , 13 , 14 ].…”

“…Additionally, some patients are discussed at the multidisciplinary tumor board meeting. Studies investigating the effects of regionalization have demonstrated superior outcomes [ 12 , 13 , 14 ], but only one examined wait times [ 15 ] in patients with lung cancer and found no differences before and after regionalization. Such an investigation has not yet been conducted in esophageal cancer in North America.…”