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Zheng X, Li C, Ai J, Dong G, Long M, Li M, Qiu S, Huang Y, Yang G, Zhang T, Li Z. No prognostic impact of staging bone scan in patients with stage IA non-small cell lung cancer. Ann Nucl Med 2024:10.1007/s12149-024-01927-3. [PMID: 38602614 DOI: 10.1007/s12149-024-01927-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To investigate the survival benefit of preoperative bone scan in asymptomatic patients with early-stage non-small cell lung cancer (NSCLC). METHODS This retrospective study included patients with radical resection for stage T1N0M0 NSCLC between March 2013 and December 2018. During postoperative follow-up, we monitored patient survival and the development of bone metastasis. We compared overall survival, bone metastasis-free survival, and recurrence-free survival in patients with or without preoperative bone scan. Propensity score matching and inverse probability of treatment weighting were used to minimize election bias. RESULTS A total of 868 patients (58.19 ± 9.69 years; 415 men) were included in the study. Of 87.7% (761 of 868) underwent preoperative bone scan. In the multivariable analyses, bone scan did not improve overall survival (hazard ratio [HR] 1.49; 95% confidence intervals [CI] 0.91-2.42; p = 0.113), bone metastasis-free survival (HR 1.18; 95% CI 0.73-1.90; p = 0.551), and recurrence-free survival (HR 0.89; 95% CI 0.58-1.39; p = 0.618). Similar results were obtained after propensity score matching (overall survival [HR 1.28; 95% CI 0.74-2.23; p = 0.379], bone metastasis-free survival [HR 1.00; 95% CI 0.58-1.72; p = 0.997], and recurrence-free survival [HR 0.76; 95% CI 0.46-1.24; p = 0.270]) and inverse probability of treatment weighting. CONCLUSION There were no significant differences in overall survival, bone metastasis-free survival, and recurrence-free survival between asymptomatic patients with clinical stage IA NSCLC with or without preoperative bone scan.
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Affiliation(s)
- Xia Zheng
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Chunxia Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Jing Ai
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Guili Dong
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Man Long
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Mingyi Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Shilin Qiu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Yanni Huang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China
| | - Guangjun Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China
| | - Tao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China.
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Li J, Wang Y, Liu Y, Liu Q, Shen H, Ren X, Du J. Survival analysis and clinicopathological features of patients with stage IA lung adenocarcinoma. Heliyon 2024; 10:e23205. [PMID: 38169765 PMCID: PMC10758825 DOI: 10.1016/j.heliyon.2023.e23205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Background With the development of medical technology and change of life habits, early-stage lung adenocarcinoma (LUAD) has become more common. This study aimed to systematically analyzed clinicopathological factors associated to the overall survival (OS) of patients with Stage IA LUAD. Methods A total of 5942 Stage IA LUAD patients were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier methods and log-rank tests were used to compare the differences in OS. A nomogram constructed based on the Cox regression was evaluated by Concordance index (C index), calibration curve, decision curve analysis (DCA) and area under curve (AUC). And 136 patients were recruited from Shandong Province Hospital for external validation. Results Cox analysis regression indicated that 12 factors, such as Diagnosis to Treatment Interval (DTI) and Income Level, were independent prognostic factors and were included to establish the nomogram. The C-index of our novel model was 0.702, 0.724 and 0.872 in the training, internal and external validation cohorts, respectively. The 3-year and 5-year survival AUCs and calibration curves showed excellent agreement in each cohort. Some new factors in the SEER database, including DTI and Income Level, were firstly confirmed as independent prognostic factors of Stage IA LUAD patients. The distribution of these factors in the T1a, T1b, and T1c subgroups differed and had different effects on survival. Conclusion We summarized 12 factors that affect prognosis and constructed a nomogram to predict OS of Stage IA LUAD patients who underwent operation. For the first time, new SEER database parameters, including DTI and Income Level, were proved to be survival-related.
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Affiliation(s)
- Jiahao Li
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Yadong Wang
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Yong Liu
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Qiang Liu
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Hongchang Shen
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, PR China
| | - Xiaoyang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, PR China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital, Shandong University, Jinan, PR China
- Department of Thoracic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, PR China
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Bassiri A, Badrinathan A, Alvarado CE, Kwak M, Sinopoli J, Tapias Vargas L, Linden PA, Towe CW. Evaluating the Optimal Time Between Diagnosis and Surgical Intervention for Early-Stage Lung Cancer. J Surg Res 2023; 292:297-306. [PMID: 37683454 DOI: 10.1016/j.jss.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION There is no consensus on the optimal timing for lung cancer surgery. We aim to evaluate the impact of timing of surgical intervention. We hypothesize delay in intervention is associated with worse overall survival and higher pathologic upstaging in early-stage lung cancer. METHODS We identified patients with cT1/2N0M0 nonsmall cell lung cancer in the National Cancer Database from 2004 to 2018. Patients were categorized by time to surgery groups: early (<26 d), average (26-60 d), and delayed (61-365 d). Primary outcome was overall survival and secondary outcome was pathologic upstaging. Multivariate models and survival analyses were used to determine factors associated with time from diagnosis to surgery, pathologic upstaging, and overall survival. RESULTS In multivariate model, advanced age, non-Hispanic Black patients, nonprivate insurance, low median income and education, and treatment at low-volume facilities were less likely to undergo early intervention and compared to the average group were more likely to receive delayed intervention. Pathologic upstaging was more likely in the delayed group (odds ratio 1.11, 1.07-1.14) compared to early group (odds ratio 0.96, 0.93-0.99). Early intervention was associated with improved overall survival (hazard ratio 0.93, 0.91-0.95), while delayed intervention was associated with inferior survival (hazard ratio 1.11, 1.09-1.14). CONCLUSIONS Expeditious surgical intervention is associated with lower rates of pathologic upstaging and improved overall survival in early-stage lung cancer. Delays in surgery are associated with social and economic factors, suggesting disparities in access to surgery. Lung cancer surgery should be performed as quickly as possible to maximize oncologic outcomes.
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Affiliation(s)
- Aria Bassiri
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Minyoung Kwak
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leonidas Tapias Vargas
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Sugumar K, Hue JJ, Gupta S, Elshami M, Rothermel LD, Ocuin LM, Ammori JB, Hardacre JM, Winter JM. Trends in and Prognostic Significance of Time to Treatment in Pancreatic Cancer: A Population-Based Study. Ann Surg Oncol 2023; 30:8610-8620. [PMID: 37624518 DOI: 10.1245/s10434-023-14221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION The association of time to treatment (TTT) with survival remains unclear in pancreatic adenocarcinoma (PDAC). In this study, we evaluate the recent trends in TTT, causes for delay, and its effect on survival. METHODS We included patients with PDAC of all stages from the National Cancer Database (2004-2020) who underwent either surgery or chemotherapy/radiotherapy (CT/RT). TTT was defined as the duration between tissue diagnosis and first treatment. Linear regression (β) was used to study the temporal trends in time delay. RESULTS A total of 239,638 patients were included. The median TTT was 25 days. Using multivariable analysis, we found that increasing age (OR 1.48), female gender (OR 1.04), Black race (OR 1.3), lower educational status (OR 1.2), Medicaid, Medicare insurance, and uninsured (OR 1.2, 1.5, and 1.2, respectively), treatment at academic centers (OR 1.3), higher Charlson-Deyo comorbidity index (OR 1.2), and CT/RT (OR 1.5) were associated with increased TTT. There was a steady rise in median TTT from 21 to 28 days between 2004 and 2020 (β = 0.3), suggestive of a worsening trend. Concurrently, there was an increasing trend in utilization of neoadjuvant CT/RT between 2004 and 2020 in early-stage PDAC. On Cox regression, TTT delay was associated with poor overall survival in stage I-IV patients (HR 1.1, 1.1, 1.09, and 1.53, respectively). CONCLUSIONS Delayed treatment approaching 2 months was observed in 10% of the population. The rising temporal trend in TTT may be attributed to the increasing shift toward neoadjuvant CT/RT in early-stage PDAC and/or the increasing use of tissue biopsy prior to surgery.
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Affiliation(s)
- Kavin Sugumar
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA.
| | - Jonathan J Hue
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Shreya Gupta
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Mohamedraed Elshami
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Lee M Ocuin
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, University Hospitals Seidman Cancer Center and Case Comprehensive Cancer Center, University Hospitals Cleveland Medical, Cleveland, OH, USA
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Hess LM, Peterson P, Sugihara T, Bhandari NR, Krein PM, Sireci A. Initial versus early switch to targeted therapy during first-line treatment among patients with biomarker-positive advanced or metastatic non-small cell lung cancer in the United States. Cancer Treat Res Commun 2023; 37:100761. [PMID: 37717466 DOI: 10.1016/j.ctarc.2023.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES This study compared outcomes between patients with biomarker-positive advanced/metastatic non-small cell lung cancer (a/mNSCLC) who initiated treatment with targeted therapy versus those who initiated chemotherapy-based treatment and switched to targeted therapy during the first ∼3 cycles (defined as the first 56 days) of first-line treatment. MATERIALS AND METHODS This was an observational study of patients with a/mNSCLC who received targeted therapy from a nationwide electronic health record (EHR)-derived de-identified database. Outcomes were compared between those who initiated targeted therapy versus those who switched from chemotherapy to a targeted agent. Time-to-event outcomes were evaluated using Kaplan-Meier method; Cox proportional hazards models (adjusted for baseline covariates) were used to compare outcomes between groups. RESULTS Of the 4,244 patients in this study, 3,107 (73.2%) initiated the first line with targeted therapy and 346 (8.2%) switched to targeted therapy. Patients who received initial targeted therapy were significantly more likely to be non-smokers, treated in an academic practice setting, and of slightly older age (all p < 0.05). Patients who received initial targeted therapy also had a significantly longer time to start of first-line treatment (35.8 vs 25.3 days, p < 0.001). No significant differences were observed for clinical outcomes between groups. CONCLUSION In both unadjusted and adjusted analyses, there were no differences in the clinical outcomes observed among patients with a/mNSCLC in this study. This study found that initiating chemotherapy with an early switch to targeted therapy (within 56 days) of receiving biomarker positive results may be an acceptable strategy for a patient for whom immediate care is needed.
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Teng J, Liu Y, Xia J, Luo Y, Zou H, Wang H. Impact of time-to-treatment initiation on survival in single primary non-small cell lung Cancer: A population-based study. Heliyon 2023; 9:e19750. [PMID: 37810045 PMCID: PMC10559072 DOI: 10.1016/j.heliyon.2023.e19750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Background Understanding the effects of a delayed time-to-treatment initiation(TTI) for non-small cell lung cancer (NSCLC) is vital. Methods We analyzed NSCLC data from the Surveillance, Epidemiology, and End Results database, focusing on lung adenocarcinoma (LUAD) and lung squamous carcinoma (LUSC). TTI was studied as both continuous and dichotomous variables. Restricted cubic splines were employed to identify potential nonlinear dependency between the hazard ratio (HR) and TTI. Propensity score matching was used to ensure a balanced patient allocation, and then survival differences between groups were assessed using Kaplan-Meier analysis and competing risk models. We used overall survival (OS) as the primary outcome and cancer-specific cumulative mortality (CSCM) as a complementary indicator. Finally, sensitivity analyses were performed on censored data. Results A total of 80,020 with NSCLC were analyzed. TTI was assessed as a continuous variable, showing a noticeable increase in the HR for stage I to II NSCLC with TTI >1 month. Conversely, the trend for stage III to IV NSCLC was the opposite. In stage I LUAD, the 'early' group demonstrated a higher OS compared to the 'delayed' group (Log-rank P = 0.002), while there was no significant difference in CSCM (Fine-gray P = 0.321). In stage I LUSC, there was no significant difference in OS(Log-rank P = 0.260), but the 'early' group had a lower CSCM (Fine-gray P = 0.018). For stage II-IV NSCLC, the 'delayed' group did not exhibit a negative impact on OS or CSCM. The sensitivity analysis further supported the results of the main analysis. Conclusion Prolongation of TTI ≥31 days has a negative impact on OS or CSCM in stage I NSCLC only. Further exploration and validation are needed to determine whether these results can be used as evidence for a 'safe' TTI threshold setting for future NSCLC.
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Affiliation(s)
- Jun Teng
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Yan Liu
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Junyan Xia
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Yi Luo
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Heng Zou
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
| | - Hongwu Wang
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, Beijing, China
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Hooshangnejad H, Chen Q, Feng X, Zhang R, Farjam R, Voong KR, Hales RK, Du Y, Jia X, Ding K. DAART: a deep learning platform for deeply accelerated adaptive radiation therapy for lung cancer. Front Oncol 2023; 13:1201679. [PMID: 37483512 PMCID: PMC10359160 DOI: 10.3389/fonc.2023.1201679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose The study aimed to implement a novel, deeply accelerated adaptive radiation therapy (DAART) approach for lung cancer radiotherapy (RT). Lung cancer is the most common cause of cancer-related death, and RT is the preferred medically inoperable treatment for early stage non-small cell lung cancer (NSCLC). In the current lengthy workflow, it takes a median of four weeks from diagnosis to RT treatment, which can result in complete restaging and loss of local control with delay. We implemented the DAART approach, featuring a novel deepPERFECT system, to address unwanted delays between diagnosis and treatment initiation. Materials and methods We developed a deepPERFECT to adapt the initial diagnostic imaging to the treatment setup to allow initial RT planning and verification. We used data from 15 patients with NSCLC treated with RT to train the model and test its performance. We conducted a virtual clinical trial to evaluate the treatment quality of the proposed DAART for lung cancer radiotherapy. Results We found that deepPERFECT predicts planning CT with a mean high-intensity fidelity of 83 and 14 HU for the body and lungs, respectively. The shape of the body and lungs on the synthesized CT was highly conformal, with a dice similarity coefficient (DSC) of 0.91, 0.97, and Hausdorff distance (HD) of 7.9 mm, and 4.9 mm, respectively, compared with the planning CT scan. The tumor showed less conformality, which warrants acquisition of treatment Day1 CT and online adaptive RT. An initial plan was designed on synthesized CT and then adapted to treatment Day1 CT using the adapt to position (ATP) and adapt to shape (ATS) method. Non-inferior plan quality was achieved by the ATP scenario, while all ATS-adapted plans showed good plan quality. Conclusion DAART reduces the common online ART (ART) treatment course by at least two weeks, resulting in a 50% shorter time to treatment to lower the chance of restaging and loss of local control.
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Affiliation(s)
- Hamed Hooshangnejad
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Carnegie Center of Surgical Innovation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Quan Chen
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Xue Feng
- Carina Medical, Lexington, KY, United States
| | - Rui Zhang
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Reza Farjam
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Khinh Ranh Voong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Russell K. Hales
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Yong Du
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Xun Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Carnegie Center of Surgical Innovation, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Pujol JL, Mercier G, Vasile M, Serre I, Vernhet-Kovacsik H, Bommart S. Brief Report: A Multidisciplinary Initial Workup for Suspected Lung Cancer as Fast-Track Intervention to Histopathologic Diagnosis. JTO Clin Res Rep 2023; 4:100526. [PMID: 37333015 PMCID: PMC10275718 DOI: 10.1016/j.jtocrr.2023.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Guidelines for optimal timing of lung cancer diagnosis and treatment have been implemented in many countries, but the effect of fast-track interventions on the shortening of time interval is still debatable. In this study, the delay from the first specialist visit to the histopathologic diagnosis was compared between two patient cohorts: before (n = 280) and after (n = 247) implementation of a fast-track multidisciplinary diagnosis program. The cumulative incidence function curves were compared, and hazard ratio was adjusted in the Cox model. The implementation allowed a statistically significant increase in the cumulative incidence of the lung cancer histopathologic diagnosis over time. Adjusted hazard ratio for patients accrued in the post-implementation cohort was 1.22 (1.03-1.45) (p = 0.023), corresponding to a reduction of this waiting period by 18%. In conclusion, a multidisciplinary approach of the diagnostic process implemented at the initial visit allows a significant reduction of the timeline until the histopathologic diagnosis of lung cancer.
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Affiliation(s)
- Jean-Louis Pujol
- Thoracic Oncology Unit, University Hospital of Montpellier, Montpellier, France
- Cancerology Resarch Institute of Montpellier (IRCM), National Institute for Health and Medical Research (INSERM) Unit-U1194, Montpellier, France
| | - Grégoire Mercier
- Data-Science Unit, University Hospital of Montpellier, Montpellier, France
- UMR UA11 Desbrest Institute of Epidemiology and Public Health (IDESP) French National Centre for Scientific Research (CNRS), University of Montpellier, Montpellier, France
| | - Maria Vasile
- Data-Science Unit, University Hospital of Montpellier, Montpellier, France
| | - Isabelle Serre
- Pathological Department, University Institute for Clinical Research, Montpellier, France
| | | | - Sébastien Bommart
- Department of Medical Imaging, University Hospital of Montpellier, Montpellier, France
- UMR 9214 French National Centre for Scientific Research (CNRS), National Institute for Health and Medical Research (INSERM) U1046, PhyMedExp University of Montpellier, Montpellier, France
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Banks KC, Dusendang JR, Schmittdiel JA, Hsu DS, Ashiku SK, Patel AR, Sakoda LC, Velotta JB. Association of Surgical Timing with Outcomes in Early Stage Lung Cancer. World J Surg 2023; 47:1323-1332. [PMID: 36695837 PMCID: PMC10070299 DOI: 10.1007/s00268-023-06913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Optimal time to surgery for lung cancer is not well established. We aimed to assess whether time to surgery correlates with outcomes. METHODS We assessed patients 18-84 years old who were diagnosed with stage I/II lung cancer at our integrated healthcare system from 2009 to 2019. Time to surgery was defined to start with disease confirmation (imaging or biopsy) prior to the surgery scheduling date. Outcomes of unplanned return to care within 30 days of lung cancer surgery, all-cause mortality, and disease recurrence were compared based on time to surgery before and after 2, 4, and 12 weeks. RESULTS Of 2861 included patients, 70% were over 65 years old and 61% were female. Time to surgery occurred in 1-2 weeks for 6%, 3-4 weeks for 31%, 5-12 weeks for 58%, and 13-26 weeks for 5% of patients. Patients with time to surgery > 4 (vs. ≤ 4) weeks had greater risk of both death (hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.00-1.39) and recurrence (HR 1.33, 95% CI 1.10-1.62). Associations were not statistically significant when dichotomizing time to surgery at 2 or 12 weeks for death (2 week HR 1.23, 95% CI 0.93-1.64; 12 week HR 1.35, 95% CI 0.97-1.88) and recurrence (2 week HR 1.54, 95% CI 0.85-2.80; 12 week HR 2.28, 95% CI 0.80-6.46). CONCLUSIONS Early stage lung cancer patients with time to surgery within 4 weeks experienced lower rates of recurrence. Optimal time to surgical resection may be shorter than previously reported.
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Affiliation(s)
- Kian C Banks
- Department of Surgery, UCSF East Bay, 1411 E 31St St, Oakland, CA, 94602, USA.
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Jennifer R Dusendang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Diana S Hsu
- Department of Surgery, UCSF East Bay, 1411 E 31St St, Oakland, CA, 94602, USA
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Simon K Ashiku
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Ashish R Patel
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
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10
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Pasli M, Kannaiyan R, Namireddy P, Walker P, Muzaffar M. Impact of Race on Outcomes of Advanced Stage Non-Small Cell Lung Cancer Patients Receiving Immunotherapy. Curr Oncol 2023; 30:4208-4221. [PMID: 37185434 PMCID: PMC10136836 DOI: 10.3390/curroncol30040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The impact of race in advanced stage non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) is conflicting. Our study sought to examine racial disparities in time to treatment initiation (TTI), overall survival (OS), and progression-free survival (PFS) using a population that was almost equally black and white. METHODS This was a retrospective cohort study of stage IV NSCLC patients > 18 years receiving immunotherapy at our center between 2014 and 2021. Kaplan-Meier curves and the multivariate Cox proportional hazards model determined the predictors of OS and PFS. Analyses were undertaken using IBM PSAW (SPSS v.28). RESULTS Out of 194 patients who met the inclusion criteria, 42.3% were black (n = 82). In the multivariate analysis, there was no difference in PFS (HR: 0.96; 95% CI: 0.66,1.40; p = 0.846) or OS (HR: 0.99; 95% CI: 0.66, 1.48; p = 0.966). No difference in treatment selection was observed between white and black patients (p = 0.363), nor was there a difference observed in median time to overall treatment initiation (p = 0.201). CONCLUSIONS No difference was observed in OS and PFS in black and white patients. Black patients' reception of timelier immunotherapy was an unanticipated finding. Future studies are necessary to better understand how race impacts patient outcomes.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA
| | - Radhamani Kannaiyan
- Division of Hospital Medicine, Eat Carolina University Health, 2100 Stantonsburg Road, Greenville, NC 27834, USA
| | - Praveen Namireddy
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
| | | | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
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11
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Tang A, Ahmad U, Raja S, Bribriesco AC, Sudarshan M, Rappaport J, Khorana A, Blackstone EH, Murthy SC, Raymond D. How Much Delay Matters? How Time to Treatment Impacts Overall Survival in Early Stage Lung Cancer. Ann Surg 2023; 277:e941-e947. [PMID: 34793347 PMCID: PMC9114165 DOI: 10.1097/sla.0000000000005307] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify drivers of time from diagnosis to treatment (TTT) of surgically resected early stage non-small cell lung cancer (NSCLC) and determine the effect of TTT on post-resection survival. SUMMARY BACKGROUND DATA Large database studies that lack relevant comorbidity data have identified longer TTT asa driver of worse overall survival. METHODS From January 1, 2014 to April 1, 2018, 599 patients underwent lung resection for clinical stage I and II NSCLC. Random forest classification, regression, and survival were used to estimate likelihood of TTT = 0 (tissue diagnosis obtained at surgery), >0 (diagnosis obtained pre-resection), and effect of TTT on all-cause mortality. RESULTS Patients with TTT > 0 (n = 413) had median TTT of 42 days (25-75 th percentile: 27-59 days). Patients with TTT = 0 (n = 186) had smaller tumors and higher percent predicted forced expiratory volume in 1 second (FEV 1 %). Patients with history of stroke, oncology consultation, invasive mediastinal staging, low and high extremes of FEV 1 % had longer TTT. Higher clinical stage, lack of preoperative stress test, anemia, older age, lower FEV1% and diffusion lung capacity, larger tumor size, and longer TTT were the most important predictors of all-cause mortality. One- and 5-year overall survival decreased when TTT was >50 days. CONCLUSIONS Preoperative physiologic workup and multidisciplinary evaluation were the predominant drivers of longer TTT. Patients with TTT = 0have more favorable presentation and should be considered in TTT analyses for early stage lung cancer populations. The time needed to clinically stage and optimize patients for resection is not deleterious to overall survival until resection is performed after 50 days from diagnosis.
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Affiliation(s)
- Andrew Tang
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
- Taussig Cancer Center, Cleveland Clinic
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
- Taussig Cancer Center, Cleveland Clinic
| | - Alejandro C. Bribriesco
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
| | - Monisha Sudarshan
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
| | - Jesse Rappaport
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
| | | | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
- Quantitative Health Sciences, Cleveland Clinic
| | - Sudish C. Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
- Taussig Cancer Center, Cleveland Clinic
| | - Daniel Raymond
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic
- Taussig Cancer Center, Cleveland Clinic
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12
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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13
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Muslim Z, Stroever S, Razi SS, Poulikidis K, Baig MZ, Connery CP, Bhora FY. Increasing Time-to-Treatment for Lung Cancer: Are We Going Backward? Ann Thorac Surg 2023; 115:192-199. [PMID: 35780818 DOI: 10.1016/j.athoracsur.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment delays in lung cancer care in the United States may be attributable to a diverse range of patient, provider, and institutional factors, the precise contributions of which remain unclear. The objective of our study was to use the National Cancer Database to investigate specific predictors of increased time-to-treatment initiation. METHODS We identified 567 783 patients undergoing treatment for stage I to stage IV non-small cell lung cancer during 2010 to 2018. Time-to-treatment initiation was defined as the number of days from radiologic diagnosis to initiation of first treatment. We used mixed effect negative binomial regression to determine predictors of time-to-treatment initiation. RESULTS We noted a steady rise in the overall mean time-to-treatment initiation interval from 33 days (2010) to 39 days (2018; P < .01). Black race, a later year at diagnosis, nonprivate insurance, and diagnosis and treatment at different facilities were independent predictors of increased time-to-treatment initiation, irrespective of disease stage. Compared with White race, Black race corresponded to a 15% to 20% increase in time-to-treatment initiation, depending on disease stage (P < .01). For stages I and II, radiation as first course of therapy corresponded with a 69% and 33% increase in time-to-treatment initiation, respectively, compared with surgery (P < .01). CONCLUSIONS Lung cancer treatment initiation times have seen an upward trajectory in recent years. Black patients encountered significantly longer treatment initiation times, regardless of treatment modality or disease stage. Prolonged initiation times appear to contribute to existing health care disparities by disproportionately affecting medically underserved communities.
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Affiliation(s)
- Zaid Muslim
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut.
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health, Danbury, Connecticut
| | - Syed S Razi
- Division of Thoracic Surgery, Department of Surgery, Memorial Healthcare System, Hollywood, Florida
| | | | - Mirza Zain Baig
- Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut
| | - Cliff P Connery
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
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14
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Li C, Malapati SJ, Guire JT, Hutchins LF. Consistency Between State's Cancer Registry and All-Payer Claims Database in Documented Radiation Therapy Among Patients Who Received Breast Conservative Surgery. JCO Clin Cancer Inform 2023; 7:e2200099. [PMID: 36724402 PMCID: PMC10166563 DOI: 10.1200/cci.22.00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Arkansas is one of only four known states that have linked All-Payer Claims Database (APCD) to state's cancer registry (Arkansas Cancer Registry [ACR]). We evaluated the reporting consistency of radiation therapy (RT) between the two sources. METHODS Women age ≥ 18 years diagnosed in 2013-2017 with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery were identified. Patients must have continuous insurance coverage (any private plans, Medicaid, and Medicare) in the 13 months (month of diagnosis and 12 months after). Receipt of RT was identified independently from ACR and APCD. We calculated sensitivity, specificity, positive predictive value, and negative predictive value for receipt of RT coded by the registry compared with APCD billing claims as the gold standard. We assessed the degree of concordance between the data sources by Cohen's kappa statistics. RESULTS The final sample included 2,695 patients who were in both databases and satisfied our inclusion/exclusion criteria. Using APCD as the gold standard, there were high sensitivity (88.1%) and positive predictive value (87.7%) and moderate specificity (71.1%) and negative predictive value (71.8%). The overall agreement between the two sources was 83.0%, with a kappa statistic of 0.59 (95% CI, 0.56 to 0.63). Consistency measures varied by age, stage, and insurance type with Medicare fee-for-service coverage only having the best and private insurance only the worse consistency. CONCLUSION In patients with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery, recording of RT receipt was moderately consistent between Arkansas APCD and ACR. Future studies are needed to identify factors affecting reporting consistency to better use this unique resource in addressing population health problems.
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Affiliation(s)
- Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sindhu J. Malapati
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - John T. Guire
- Cancer Administration Service Line, Cancer Registry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Laura F. Hutchins
- Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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15
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Raval AA, Benn BS, Benzaquen S, Maouelainin N, Johnson M, Huang J, Lofaro LR, Ansari A, Geurink C, Kennedy GC, Bulman WA, Kurman JS. Reclassification of risk of malignancy with Percepta Genomic Sequencing Classifier following nondiagnostic bronchoscopy. Respir Med 2022; 204:106990. [DOI: 10.1016/j.rmed.2022.106990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/30/2022] [Accepted: 09/11/2022] [Indexed: 10/31/2022]
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16
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Pitter JG, Moizs M, Ezer ÉS, Lukács G, Szigeti A, Repa I, Csanádi M, Rutten-van Mölken MPMH, Islam K, Kaló Z, Vokó Z. Improved survival of non-small cell lung cancer patients after introducing patient navigation: A retrospective cohort study with propensity score weighted historic control. PLoS One 2022; 17:e0276719. [PMID: 36282840 PMCID: PMC9595513 DOI: 10.1371/journal.pone.0276719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
OnkoNetwork is a patient navigation program established in the Moritz Kaposi General Hospital to improve the timeliness and completeness of cancer investigations and treatment. The H2020 SELFIE consortium selected OnkoNetwork as a promising integrated care initiative in Hungary and conducted a multicriteria decision analysis based on health, patient experience, and cost outcomes. In this paper, a more detailed analysis of clinical impacts is provided in the largest subgroup, non-small cell lung cancer (NSCLC) patients. A retrospective cohort study was conducted, enrolling new cancer suspect patients with subsequently confirmed NSCLC in two annual periods, before and after OnkoNetwork implementation (control and intervention cohorts, respectively). To control for selection bias and confounding, baseline balance was improved via propensity score weighting. Overall survival was analyzed in univariate and multivariate weighted Cox regression models and the effect was further characterized in a counterfactual analysis. Our analysis included 123 intervention and 173 control NSCLC patients from early to advanced stage, with significant between-cohort baseline differences. The propensity score-based weighting resulted in good baseline balance. A large survival benefit was observed in the intervention cohort, and intervention was an independent predictor of longer survival in a multivariate analysis when all baseline characteristics were included (HR = 0.63, p = 0.039). When post-baseline variables were included in the model, belonging to the intervention cohort was not an independent predictor of survival, but the survival benefit was explained by slightly better stage distribution and ECOG status at treatment initiation, together with trends for broader use of PET-CT and higher resectability rate. In conclusion, patient navigation is a valuable tool to improve cancer outcomes by facilitating more timely and complete cancer diagnostics. Contradictory evidence in the literature may be explained by common sources of bias, including the wait-time paradox and adjustment to intermediate outcomes.
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Affiliation(s)
| | | | | | - Gábor Lukács
- Moritz Kaposi General Hospital, Kaposvár, Hungary
| | | | - Imre Repa
- Moritz Kaposi General Hospital, Kaposvár, Hungary
| | | | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
- NORCE-Norwegian Research Centre, Bergen, Norway
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- * E-mail:
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17
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Liu B, Qian JY, Wu LL, Zeng JQ, Xu SQ, Yuan JH, Zheng YL, Xie D, Chen X, Yu HH. A long waiting time from diagnosis to treatment decreases the survival of non-small cell lung cancer patients with stage IA1: A retrospective study. Front Surg 2022; 9:987075. [PMID: 36157427 PMCID: PMC9489994 DOI: 10.3389/fsurg.2022.987075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe prognostic effect of delayed treatment on stage IA1 non-small cell lung cancer (NSCLC) patients is still unclear. This study aimed to explore the association between the waiting time before treatment and the prognosis in stage IA1 NSCLC patients.MethodsEligible patients diagnosed with pathological stage IA1 NSCLC were included in this study. The clinical endpoints were overall survival (OS) and cancer-specific survival (CSS). The Kaplan-Meier method, the Log-rank test, univariable, and multivariable Cox regression analyses were used in this study. Propensity score matching was used to reduce the bias of data distribution.ResultsThere were eligible 957 patients in the study. The length of waiting time before treatment stratified the survival in patients [<3 months vs. ≥3-months, unadjusted hazard ratio (HR) = 0.481, P = 0.007; <2 months vs. ≥2-months, unadjusted HR = 0.564, P = 0.006; <1 month vs. ≥1-month, unadjusted HR = 0.537, P = 0.001]. The 5-year CSS rates were 95.0% and 77.0% in patients of waiting time within 3 months and over 3 months, respectively. After adjusting for other confounders, the waiting time was identified as an independent prognostic factor.ConclusionsA long waiting time before treatment may decrease the survival of stage IA1 NSCLC patients. We propose that the waiting time for those patients preferably is less than one month and should not exceed two months.
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Affiliation(s)
- Bin Liu
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Jia-Yi Qian
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei-Lei Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun-Quan Zeng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Shu-Quan Xu
- School of Medicine, Tongji University, Shanghai, China
| | - Jin-Hua Yuan
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Yong-Liang Zheng
- Department of Oncology, The Affiliated Hospital of Jinggangshan University, Ji’an, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Xiaolu Chen
- Department of Respiratory and Critical Care, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
| | - Hai-Hong Yu
- School of Medicine, Tongji University, Shanghai, China
- School of Medicine, Jinggangshan University, Ji'an, China
- Correspondence: Hai-Hong Yu Xiaolu Chen Dong Xie
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18
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Hall H, Tocock A, Burdett S, Fisher D, Ricketts WM, Robson J, Round T, Gorolay S, MacArthur E, Chung D, Janes SM, Peake MD, Navani N. Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review. Thorax 2022; 77:762-768. [PMID: 34404753 PMCID: PMC9340041 DOI: 10.1136/thoraxjnl-2021-216865] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. METHODS Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. RESULTS Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease. CONCLUSION There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.
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Affiliation(s)
- Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
| | - Adam Tocock
- Barts Health Knowledge and Library Services, Barts Health NHS Trust, London, UK
| | | | - David Fisher
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | | | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sarita Gorolay
- XX Place Health Centre, London Borough of Tower Hamlets, London, UK
| | - Emma MacArthur
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
| | - Donna Chung
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
| | - Michael D Peake
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
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19
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Garg A, Iyer H, Jindal V, Vashistha V, Chawla G, Tiwari P, Mittal S, Madan K, Hadda V, Guleria R, Sati HC, Mohan A. Evaluation of delays during diagnosis and management of lung cancer in India: A prospective observational study. Eur J Cancer Care (Engl) 2022; 31:e13621. [DOI: 10.1111/ecc.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Avneet Garg
- Department of Pulmonary Medicine Adesh Institute of Medical Sciences and Research Bathinda India
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hariharan Iyer
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vinita Jindal
- Department of Radiology Adesh Institute of Medical Sciences and Research Bathinda India
| | - Vishal Vashistha
- Department of Hematology and Oncology New Mexico Veterans Affairs Medical Center Albuquerque New Mexico USA
- United States‐India Educational Foundation‐Nehru Senior Scholarship Program Delhi India
| | - Gopal Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Pawan Tiwari
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Saurabh Mittal
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Karan Madan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Vijay Hadda
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
| | - Hem C. Sati
- Department of Biostatistics All India Institute of Medical Sciences Delhi India
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care and Sleep Medicine All India Institute of Medical Sciences Delhi India
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20
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Charlot M, Stein JN, Damone E, Wood I, Forster M, Baker S, Emerson M, Samuel-Ryals C, Yongue C, Eng E, Manning M, Deal A, Cykert S. Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery. J Clin Oncol 2022; 40:1755-1762. [PMID: 35157498 PMCID: PMC9148687 DOI: 10.1200/jco.21.01745] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non-small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. METHODS We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. RESULTS A total of 2,363 patients with stage I and II non-small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group (P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group (P < .01) and 64.9% of Black patients and 73.2% of White patients (P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). CONCLUSION Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.
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Affiliation(s)
- Marjory Charlot
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Greensboro Health Disparities Collaborative, Greensboro, NC
| | - Jacob Newton Stein
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Emily Damone
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Isabella Wood
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Moriah Forster
- Department of Internal Medicine, University of North Carolina, Chapel Hill, NC
| | - Stephanie Baker
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Department of Public Health Studies, Elon University, Elon, NC
| | - Marc Emerson
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Cleo Samuel-Ryals
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Christina Yongue
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC
| | - Eugenia Eng
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Matthew Manning
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Cone Health Cancer Center, Greensboro, NC
| | - Allison Deal
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Samuel Cykert
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Greensboro Health Disparities Collaborative, Greensboro, NC
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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21
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers OCJ. Impact of time-to-treatment on survival for advanced non-small cell lung cancer patients in the Netherlands: a nationwide observational cohort study. Thorax 2022; 78:467-475. [PMID: 35450944 DOI: 10.1136/thoraxjnl-2021-218059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The assumption that more rapid treatment improves survival of advanced non-small cell lung cancer (NSCLC) has not yet been proven. We studied the relation between time-to-treatment and survival in advanced stage NSCLC patients in a large multicentric nationwide retrospective cohort. Additionally, we identified factors associated with delay. METHOD We selected 10 306 patients, diagnosed and treated between 2014 and 2019 for clinical stage III and IV NSCLC, from the Netherlands Cancer Registry that includes nationwide data from 109 Dutch hospitals. Associations between survival and time-to-treatment were tested with Cox proportional hazard regression analyses. Time-to-treatment was adjusted for multiple covariates including diagnostic procedures and type of therapy. Factors associated with delay were identified by multilevel logistic regression. RESULTS Risk of death significantly decreased with longer time-to-treatment for stage III patients receiving only radiotherapy (adjusted HR, aHR >21 days: 0.59 (95% CI 0.48 to 0.73)) or any type of systemic therapy (aHR >49 days: 0.72 (95% CI 0.56 to 0.91)) and stage IV patients receiving chemotherapy and/or immunotherapy (aHR >21 days: 0.81 (95% CI 0.73 to 0.88)). No significant association was found for stage III patients treated with chemoradiotherapy and stage IV patients treated with targeted therapy. More complex diagnostic procedures often delay treatment. CONCLUSION Although in general it is important to start treatment as early as possible, our study finds no evidence that a more rapid start of treatment improves outcomes in advanced stage NSCLC patients. The benefit of urgent treatment is probably confounded by unmeasured patient and tumour characteristics and, clinical urgency dictating timelines of treatment. Time-to-treatment and its impact should be continuously evaluated as therapeutic strategies continue to evolve and improve.
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Affiliation(s)
- Sosse E Klarenbeek
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J Aarts
- Research and Development, Dutch Association of Comprehensive Cancer Centres, Utrecht, The Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C J Schuurbiers
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Nam JG, Hong H, Choi SH, Park CM, Goo JM, Kim YT, Kim H. No Prognostic Impact of Staging Brain MRI in Patients with Stage IA Non-Small Cell Lung Cancer. Radiology 2022; 303:632-643. [PMID: 35258373 DOI: 10.1148/radiol.212101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Although various guidelines discourage performing brain MRI for staging purposes in asymptomatic patients with clinical stage IA non-small cell lung cancer (NSCLC), evidence regarding their postoperative survival is lacking. Purpose To investigate the survival benefit of performing brain MRI in asymptomatic patients with early-stage NSCLC. Materials and Methods Patients who underwent curative resection between February 2009 and March 2016 for clinical TNM stage T1N0M0 NSCLC were retrospectively included. Patient survival and development of brain metastasis during postoperative surveillance were documented. The cumulative survival rate and incidence of brain metastasis were compared between patients who underwent surgery with or without staging brain MRI by using Cox regression and a Fine-Gray subdistribution hazard model, respectively, for multivariable adjustment. Propensity score matching and inverse probability of treatment weighting were applied for confounder adjustment. Results A total of 628 patients (mean age, 64 years ± 10 [SD]; 319 men) were included, of whom 53% (331 of 628) underwent staging brain MRI. In the multivariable analyses, brain MRI did not show prognostic benefits for brain metastasis-free survival (hazard ratio [HR], 1.06; 95% CI: 0.69, 1.63; P = .79), time to brain metastasis (HR, 1.60; 95% CI: 0.70, 3.94; P = .29), and overall survival (HR, 0.86; 95% CI, 0.54, 1.37; P = .54). Consistent results were obtained after propensity score matching (brain metastasis-free survival [HR, 0.97; 95% CI: 0.60, 1.57; P = .91], time to brain metastasis [HR, 1.29; 95% CI: 0.50, 3.33; P = .60], and overall survival [HR, 0.89; 95% CI: 0.53, 1.51; P = .67]) and inverse probability of treatment weighting. Conclusion No difference was observed between asymptomatic patients with clinical stage IA non-small cell lung cancer who underwent staging brain MRI and those who did not in terms of brain metastasis-free survival, time to brain metastasis, and overall survival. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Bizzi and Pascuzzo in this issue.
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Affiliation(s)
- Ju G Nam
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyunsook Hong
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Seung Hong Choi
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Chang Min Park
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Jin Mo Goo
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Young Tae Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
| | - Hyungjin Kim
- From the Department of Radiology (J.G.N., S.H.C., C.M.P., J.M.G., H.K.) and Department of Thoracic and Cardiovascular Surgery (Y.T.K.), Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea (H.H.); Institute of Radiation Medicine (S.H.C., C.M.P., J.M.G.) and Institute of Medical and Biological Engineering (C.M.P.), Seoul National University Medical Research Center, Seoul, Republic of Korea; and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea (S.H.C., C.M.P., J.M.G., Y.T.K.)
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23
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Clinical impact of delays in the management of lung cancer patients in the last decade: systematic review. Clin Transl Oncol 2022; 24:1549-1568. [PMID: 35257298 PMCID: PMC8900646 DOI: 10.1007/s12094-022-02796-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Due to the importance of lung cancer early treatment because of its severity and extent worldwide a systematic literature review was conducted about the impact of delays in waiting times on the disease prognosis. MATERIALS AND METHODS We conducted a systematic search of observational studies (2010-2020) including adult patients diagnosed with lung cancer and reporting healthcare timelines and their clinical consequences. RESULTS We included 38 articles containing data on waiting times and prognosis; only 31 articles linked this forecast to a specific waiting time. We identified 41 healthcare time intervals and found medians of 6-121 days from diagnosis to treatment and 4-19.5 days from primary care to specialist visit: 37.5% of the intervals indicated better prognosis with longer waiting times. CONCLUSIONS All articles emphasized that waiting times must be reduced to achieve good management and prognosis of lung cancer. Further prospective studies are needed on the relationship between waiting times and prognosis of lung cancer.
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24
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Romine PE, Sun Q, Fedorenko C, Li L, Tang M, Eaton KD, Goulart BHL, Martins RG. Impact of Diagnostic Delays on Lung Cancer Survival Outcomes: A Population Study of the US SEER-Medicare Database. JCO Oncol Pract 2022; 18:e877-e885. [PMID: 35119911 DOI: 10.1200/op.21.00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Time from diagnosis to treatment has been associated with worse survival outcomes in non-small-cell lung cancer (NSCLC). However, little is known about the impact of delay in time to diagnosis. We aimed to evaluate the impact of time from radiographic suspicion to histologic diagnosis on survival outcomes using the US SEER-Medicare population database. METHODS We identified patients from the SEER-Medicare data set diagnosed with any stage NSCLC between January 1, 2011, and December 31, 2015, who received stage-appropriate treatment and had a computed tomography scan within 1 year of diagnosis. Time to confirmation was determined as the interval between most recent computed tomography imaging and date of histologic diagnosis. Our primary outcome was overall survival (OS). RESULTS In total, 10,824 eligible patients were identified. The median time to confirmation was 20 (range 0-363) days. Using multivariate Cox regression models, longer time to confirmation was associated with improved OS in all comers driven by stage IV patients after adjustment for age, sex, diagnosis year, histology, and comorbidity index. In a separate landmark analysis excluding patients deceased within 6 months of diagnosis, the association between time to diagnosis and survival was no longer evident. CONCLUSION Time to confirmation of NSCLC was inversely associated with OS in this US SEER population study. This association was lost when patients deceased within 6 months of diagnosis were excluded, suggesting that retrospective registry-claims databases may not be the optimal data source to study time to diagnosis as a quality metric because of the unaccounted confounding effects of tumor behavior. Prospective evaluations of clinically enriched data sources may better serve this purpose.
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Affiliation(s)
- Perrin E Romine
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mariel Tang
- Georgetown University Law Center/Johns Hopkins Bloomberg School of Public Health, Washington, DC
| | - Keith D Eaton
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Renato G Martins
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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25
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Kiss Z, Bogos K, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Knollmajer K, Várnai M, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Moldvay J, Gálffy G, Vokó Z. Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary. Pathol Oncol Res 2021; 27:1610041. [PMID: 35002544 PMCID: PMC8734146 DOI: 10.3389/pore.2021.1610041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
Objective: This study aimed to examine the characteristics of the lung cancer (LC) patient pathway in Hungary during a 6-years period. Methods: This nationwide, retrospective study included patients newly diagnosed with LC (ICD-10 C34) between January 1, 2011, and December 31, 2016, using data from the National Health Insurance Fund (NHIF) of Hungary. The following patient pathway intervals were examined: system, diagnostic and treatment interval by age, gender, tumor type, study year and first-line LC therapy. Results: During the 6-years study period, 17,386 patients had at least one type of imaging (X-ray or CT/MRI) prior to diagnosis, and 12,063 had records of both X-ray and CT/MRI. The median system interval was 64.5 days, and it was 5 days longer among women, than in men (68.0 vs. 63.0 days). The median system interval was significantly longer in patients with adenocarcinoma compared to those with squamous cell carcinoma or small cell lung cancer (70.4 vs. 64.0 vs. 48.0 days, respectively). Patients who received surgery as first-line treatment had significantly longer median system intervals compared to those receiving chemotherapy (81.4 vs. 62.0 days). The median system interval significantly increased from 62.0 to 66.0 days during the 6-years study period. Conclusion: The LC patient pathway significantly increased in Hungary over the 6-years study period. There were no significant differences in the length of the whole LC patient pathway according to age, however, female sex, surgery as first-line treatment, and adenocarcinoma were associated with longer system intervals.
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Affiliation(s)
- Zoltan Kiss
- MSD Pharma Hungary Ltd., Budapest, Hungary
- *Correspondence: Zoltan Kiss,
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary
| | - Nóra Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | - Balázs Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Krisztián Horváth
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biomathematics and Computer Science, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Athanasiou A, Spartalis E, Spartalis M. Comment on "Are We Harming Cancer Patients by Delaying Their Cancer Surgery During the COVID-19 Pandemic?". Ann Surg 2021; 274:e785-e786. [PMID: 33065645 DOI: 10.1097/sla.0000000000004542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens, Medical School, Athens, Greece
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27
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Duration of intervals in the care seeking pathway for lung cancer in Bangladesh: A journey from symptoms triggering consultation to receipt of treatment. PLoS One 2021; 16:e0257301. [PMID: 34506592 PMCID: PMC8432814 DOI: 10.1371/journal.pone.0257301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Timeliness in seeking care is critical for lung cancer patients' survival and better prognosis. The care seeking trajectory of patients with lung cancer in Bangladesh has not been explored, despite the differences in health systems and structures compared to high income countries. This study investigated the symptoms triggering healthcare seeking, preferred healthcare providers (including informal healthcare providers such as pharmacy retailers, village doctors, and "traditional healers"), and the duration of intervals in the lung cancer care pathway of patients in Bangladesh. A cross-sectional study was conducted in three tertiary care hospitals in Bangladesh among diagnosed lung cancer patients through face-to-face interview and medical record review. Time intervals from onset of symptom and care seeking events were calculated and compared between those who sought initial care from different providers using Wilcoxon rank sum tests. Among 418 study participants, the majority (90%) of whom were males, with a mean age of 57 ±9.86 years, cough and chest pain were the most common (23%) combination of symptoms triggering healthcare seeking. About two-thirds of the total respondents (60%) went to informal healthcare providers as their first point of contact. Living in rural areas, lower levels of education and lower income were associated with seeking care from such providers. The median duration between onset of symptom to confirmation of diagnosis was 121 days, between confirmation of diagnosis and initiation of treatment was 22 days, and between onset of symptom and initiation of treatment was 151 days. Pre-diagnosis durations were longer for those who had sought initial care from an informal provider (p<0.05). Time to first contact with a health provider was shorter in this study compared to other developed and developing countries but utilizing informal healthcare providers caused delays in diagnosis and initiation of treatment. Encouraging people to seek care from a formal healthcare provider may reduce the overall duration of the care seeking pathway.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Department of Respiratory & Sleep Medicine, Austin Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Melbourne, Australia
- School of Health, Federation University Australia, Berwick, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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28
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Zhang L, Hsieh MC, Rennert L, Neroda P, Wu XC, Hicks C, Wu J, Gimbel R. Diagnosis-to-surgery interval and survival for different histologies of stage I-IIA lung cancer. Transl Lung Cancer Res 2021; 10:3043-3058. [PMID: 34430346 PMCID: PMC8350104 DOI: 10.21037/tlcr-21-168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 12/25/2022]
Abstract
Background Guidelines on timeliness of lung cancer surgery are inconsistent. Lung cancer histologic subtypes have different prognosis and treatment. It is important to understand the consequences of delayed surgery for each lung cancer histologic subtype. This study aimed to examine the association between diagnosis-to-surgery time interval and survival for early stage lung cancer and selected histologic subtypes. Methods Patients diagnosed with stage I–IIA lung cancer between 2004 and 2015 receiving definitive surgery and being followed up until Dec. 31, 2018, were identified from Surveillance, Epidemiology, and End Results database. Histologic subtypes included adenocarcinoma, squamous or epidermoid carcinoma, bronchioloalveolar carcinoma, large cell carcinoma, adenosquamous carcinoma, carcinoid carcinoma, and small cell carcinoma. Diagnosis-to-surgery interval was treated as multi-categorical variables (<1, 1–2, 2–3, and ≥3 months) and binary variables (≥1 vs. <1 month, ≥2 vs. <2 months, and ≥3 vs. <3 months). Outcomes included cancer-specific and overall survival. Covariates included age at diagnosis, sex, race, marital status, tumor size, grade, surgery type, chemotherapy, radiotherapy, and study period. Kaplan-Meier survival curves and Cox proportional hazards regression models were applied to examine the survival differences. Results With a median follow-up time of 51 months, a total of 40,612 patients were analyzed, including 40.1% adenocarcinoma and 24.5% squamous or epidermoid carcinoma. The proportion of patients receiving surgery <1, 1–2, 2–3, and ≥3 months from diagnosis were 34.2%, 33.9%, 19.8%, and 12.1%, respectively. Delayed surgery was associated with worse cancer-specific and overall survival for all lung cancers, adenocarcinoma, squamous or epidermoid, bronchioloalveolar, and large cell carcinoma (20–40% increased risk). Dose-dependent effects (longer delay, worse survival) were observed in all lung cancers, adenocarcinoma, and squamous and epidermoid carcinoma. No significant association between surgery delay and survival was observed in adenosquamous, carcinoid, and small cell carcinoma. Conclusions Our findings support the guidelines of undertaking surgery within 1 month from diagnosis in patients with stage I–IIA lung cancer. The observed dose-dependent effects emphasize the clinical importance of early surgery. Future studies with larger sample size of less frequent histologic subtypes are warranted to provide more evidence for histology-specific lung cancer treatment guidelines.
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Affiliation(s)
- Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Paige Neroda
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, School of Public Health Sciences, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chindo Hicks
- Genetic Department, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jiande Wu
- Genetic Department, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ronald Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
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Zuniga PVS, Ost DE. Impact of Delays in Lung Cancer Treatment on Survival. Chest 2021; 160:1934-1958. [PMID: 34425080 DOI: 10.1016/j.chest.2021.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
Timely care is an important dimension of health care quality, but the impact of delays in care on lung cancer outcomes is unclear. Quantifying the impact of delays in cancer treatment on survival is necessary to inform resource allocation, quality improvement initiatives, and lung cancer guidelines. Review of the available literature demonstrated significant heterogeneity between studies in terms of the impact of delay. Frequently paradoxical results were reported, with delay being associated with improved survival in patients with advanced disease. However, significant methodologic flaws were identified in many studies, which probably is the reason for the paradoxical results. The most significant methodologic limitations identified were incorrectly controlling for final pathologic stage (a mediator in the causal chain from delay to survival), failure to control for confounding by acuity of cancer presentation, and failure to consider effect measure modification. The effect of delay on survival probably varies by stage. The impact of delays is lowest for subcentimeter nodules, probably highest in stage II disease, and low in patients who are only eligible for palliative care. Precise quantification of the impact of delay is not currently possible. Given the available evidence, quality metrics for the timeliness of lung cancer care should focus on local barriers to care. These metrics should be carefully designed to take into account clinical-radiographic stage at initial presentation.
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Affiliation(s)
- Paula Valeria Sainz Zuniga
- The University of Texas MD Anderson Cancer Center, Houston, TX; Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - David E Ost
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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30
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Saarenheimo J, Andersen H, Eigeliene N, Jekunen AP. Current challenges in applying gene-driven therapies in clinical lung cancer practice. World J Clin Oncol 2021; 12:656-663. [PMID: 34513599 PMCID: PMC8394160 DOI: 10.5306/wjco.v12.i8.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/12/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Over the last twenty years, with the development of gene-driven therapies, numerous new drugs have entered clinical use. Very few of these new drugs are suitable for a large number of patients, and all require molecular genetic testing. In lung cancer, gene-targeted therapy has evolved rapidly and has placed demands on the development of diagnostics and tissue sample preparation and logistics. Rapid diagnosis and prevalence assessment are necessary to determine the prognosis of a lung cancer patient based on the latest research findings. Therefore, the molecular-genetic diagnostic pathway must also be accelerated and matured to do the necessary analyses on small samples. Because lung cancer rebiopsy can be difficult, liquid biopsy techniques should be developed to cover more of the treatable mutations. There are obstacles related to tissue sampling, new genomic techniques and access to gene-driven cancer drugs, including their affordability. With this review and case study, we go into the obstacles faced by our clinic and discuss how to tackle these obstacles in lung cancer. We use lung cancer as an example due to its complexity, though these same obstacles are found in different cancers on a minor scale.
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Affiliation(s)
- Jatta Saarenheimo
- Department of Pathology, Vasa Central Hospital, Vaasa 65130, Finland
| | - Heidi Andersen
- Department of Oncology, Vasa Central Hospital, Vasa 65130, Finland
- Tema Cancer, Karolinska University Hospital, Stockholm 17177, Sweden
- Faculty of Medicine and Health Technology, University of Tampere, Tampere 33100, Finland
| | - Natalja Eigeliene
- Department of Oncology, Vasa Central Hospital, Vasa 65130, Finland
- Department of Oncology and Radiotherapy, University of Turku, Turku 20500, Finland
| | - Antti P Jekunen
- Department of Oncology, Vasa Central Hospital, Vasa 65130, Finland
- Department of Oncology and Radiotherapy, University of Turku, Turku 20500, Finland
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31
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Huepenbecker SP, Sun CC, Fu S, Zhao H, Primm K, Giordano SH, Meyer LA. Factors impacting the time to ovarian cancer diagnosis based on classic symptom presentation in the United States. Cancer 2021; 127:4151-4160. [PMID: 34347287 DOI: 10.1002/cncr.33829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with ovarian cancer often present with late-stage disease and nonspecific symptoms, but little is known about factors affecting the time to diagnosis (TTD) in the United States. METHODS A retrospective, population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted. It included women 66 years old or older with stage II to IV epithelial ovarian cancer with at least 1 code for abdominal/pelvic pain, bloating, difficulty eating, or urinary symptoms within 1 year of the cancer diagnosis. TTD was defined from the first claim with a prespecified symptom to the ovarian cancer diagnosis. Kruskal-Wallis tests were used to assess for differences in TTD by group medians. Univariate and generalized linear models with a log-link function evaluated TTD by covariables. RESULTS For the 13,872 women analyzed, the mean and median times to diagnosis were 2.9 and 1.1 months, respectively. The median TTD differed significantly by first symptom (P < .001), number of symptoms (P < .001), and first physician specialty seen (P < .001). In a multivariable analysis, TTD differed significantly according to race/ethnicity (P < .001), geographic region (P = .001), urban-rural location (P = .031), emergency room presentation (P < .001), and number of specialties seen (P < .001). A shorter TTD was associated with a diagnosis in 2006-2010 (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) or 2011-2015 (RR, 0.87; 95% CI, 0.81-0.93) in comparison with 1992-1999. CONCLUSIONS The time from a symptomatic presentation to care to a diagnosis of ovarian cancer is influenced by clinical and demographic variables. This study's findings reinforce the importance of educating all physicians on ovarian cancer symptoms to aid in diagnosis. LAY SUMMARY Ovarian cancer is often diagnosed once disease has spread because the classic symptoms of ovarian cancer-abdominal or pelvic pain, bloating, difficulty eating, and urinary issues-can be mistaken for other problems. This study examined the time between when women with classic ovarian cancer symptoms went to a physician and when they received a cancer diagnosis in a large database population. The authors found that the time to diagnosis differed according to the type and number of symptoms and what type of physician a woman saw as well as factors such as race, geographic location, and year of diagnosis.
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Affiliation(s)
- Sarah P Huepenbecker
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristin Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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32
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Lynch C, Reguilon I, Langer DL, Lane D, De P, Wong WL, Mckiddie F, Ross A, Shack L, Win T, Marshall C, Revheim ME, Danckert B, Butler J, Dizdarevic S, Louzado C, Mcgivern C, Hazlett A, Chew C, O'connell M, Harrison S. A comparative analysis: international variation in PET-CT service provision in oncology-an International Cancer Benchmarking Partnership study. Int J Qual Health Care 2021; 33:6030987. [PMID: 33306102 PMCID: PMC7896108 DOI: 10.1093/intqhc/mzaa166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services. Design Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions. Setting PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK). Participants None. Intervention(s) None. Main Outcome Measure(s) None. Results PET-CT service provision has grown over the period 2006–2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied. Conclusions Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services.
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Affiliation(s)
- Charlotte Lynch
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
| | - Irene Reguilon
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Brand & Strategy, eConsult Health Ltd, 46-48 East Street, Surrey, KT17 1HQ, UK
| | - Deanna L Langer
- Cancer Imaging, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Damon Lane
- Radiology, Pacific Radiology, 123 Victoria Street, Christchurch Central, Christchurch 8013, New Zealand
| | - Prithwish De
- Surveillance and Cancer Registry, Ontario Health (Cancer Care Ontario), 620 University Avenue, Toronto, ON M5G 2L7, Canada
| | - Wai-Lup Wong
- Nuclear Medicine, Mount Vernon Hospital, East and North Hertfordshire NHS Trust, Rickmansworth Road, Northwood, HA6 2RN, UK
| | - Fergus Mckiddie
- Nuclear Medicine and PET Department, NHS Grampian, 2 Eday Road, Aberdeen AB15 6RE, UK
| | - Andrew Ross
- Dalhousie Medical School, Dalhousie University, 6299 South Street, Halifax, Nova Scotia, NS B3H 4R2, Canada
| | - Lorraine Shack
- Surveillance and Reporting, Alberta Health Services (Cancer Control Alberta), 10030-107 Street NW, Edmonton, Alberta, T5J 3E4, Canada
| | - Thida Win
- General and Respiratory Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK
| | - Christopher Marshall
- Wales Research and Diagnostic PET Imaging Centre, Cardiff University, Cardiff University School of Medicine Health Park, Cardiff, CF14, 4XN, UK
| | - Mona-Eliszabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Pb 4950 Nydalen, Oslo, 0424, Norway
| | - Bolette Danckert
- Research Centre, Danish Cancer Society, Strandboulevarden 49, 2100 Kobenhavn, Denmark
| | - John Butler
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK.,Gynaecology Department, Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - Sabina Dizdarevic
- Imaging and Nuclear Medicine, Brighton and Sussex University Hospital Trust, Kemptown, Brighton, BN2 1ES, United Kingdom and Brighton and Sussex Medical School, University of Sussex and Brighton, London Road, Brighton, BN1 4GE, UK
| | - Cheryl Louzado
- Strategy Implementation Planning & Partner Relations, Canadian Partnership Against Cancer, 145 King St, Toronto, ON M5H 1J8, Canada
| | - Canice Mcgivern
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Anne Hazlett
- Department of Regional Medical Physics, Belfast Health and Social Care Trust, 83 Shankill Road, Belfast, BT13 1FD, UK
| | - Cindy Chew
- School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin O'connell
- Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, DO7 R2WY, Ireland
| | - Samantha Harrison
- International Cancer Benchmarking Partnership (ICBP), Policy & Information, Cancer Research UK, 2 2 Redman Place, London, E20 1JQ, UK
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Socioeconomic Disparities in Non-Small Cell Lung Cancer With Brain Metastases at Presentation: A Population-Based Study. World Neurosurg 2021; 154:e236-e244. [PMID: 34256174 DOI: 10.1016/j.wneu.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE/BACKGROUND The purpose of this study was to characterize the impact of household income disparities in the survival of patients with non-small cell lung cancer (NSCLC) presenting with brain metastasis on a population-based level. METHODS This is a population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 2010-2016 including 15,808 NSCLC patients presenting with brain metastasis. RESULTS This study comprises 15,808 adult patients with NSCLC presenting with brain metastases having an age range 64 ± 10 years with 51% male, 76% white, 52% married, 61% insured, and with 85% of lung adenocarcinoma histopathology. The 1-, 2- and 5-year survival rates for living in the lower household income quartile were 21%, 10%, and 3%, respectively, for the second quartile 24%, 10%, and 3%; for the third quartile 28%, 14%, and 4%; and for the top quartile 31%, 17%, and 4%, respectively. Multivariate Cox proportional hazard analysis showed that living in a higher quartile household income county is associated with increased survival (P < 0.0001), hazard ratio 0.87, 95% confidence interval (0.82-0.92). CONCLUSIONS This population-based study suggests that living in higher median household income counties is associated with increased survival time and reduced risk of mortality for patients with NSCLC who have brain metastases present at diagnosis, independent of other factors. These findings underscore the importance of ensuring adequate and easy access to care for all patients, irrespective of their economic background.
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Slatore CG, Miller DR, Wiener RS. Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019. JAMA Netw Open 2021; 4:e2116233. [PMID: 34236409 PMCID: PMC8267608 DOI: 10.1001/jamanetworkopen.2021.16233] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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 MEASURES Receipt 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 RELEVANCE In 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 work should focus on identifying facilities that promote high adherence and disseminating successful strategies to promote equity in LCS among marginalized populations.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Tanner J. Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan School of Medicine, Ann Arbor
| | - Sanqian Zhang
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland
| | - Donald R. Miller
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, Bedford VA Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
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Stokstad T, Sørhaug S, Amundsen T, Grønberg BH. Associations Between Time to Treatment Start and Survival in Patients With Lung Cancer. In Vivo 2021; 35:1595-1603. [PMID: 33910841 DOI: 10.21873/invivo.12416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival. PATIENTS AND METHODS The medical records of 439 lung cancer patients at a regional cancer center were reviewed and categorized according to treatment: (i) surgery; ii) radical radiotherapy; iii) stereotactic radiotherapy; iv) palliative treatment, no cancer symptoms; v) palliative treatment with severe cancer symptoms). RESULTS Proportions receiving timely treatment varied significantly at 39%, 48%, 10%, 44% and 89%, respectively (p<0.001). Overall, those starting treatment on time had the shortest median overall survival (10.6 vs. 22.6 months; p<0.001). This was also the case for palliative (5.3 vs. 11.4 months) (p<0.001) but not for curative treatment (not reached vs. 38.3 months) (p=0.038). CONCLUSION Timely treatment is not necessarily associated with improved survival.
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Affiliation(s)
- Trine Stokstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sveinung Sørhaug
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn H Grønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; .,Department of Oncology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Han KT, Kim W, Song A, Ju YJ, Choi DW, Kim S. Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients? Health Policy 2021; 125:1047-1053. [PMID: 34176673 DOI: 10.1016/j.healthpol.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Areum Song
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong-Woo Choi
- Department of Biostatistics, Yonsei University Graduate School of Public Health, Seoul, Korea
| | - Seungju Kim
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
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Ogura K, Fujiwara T, Healey JH. Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk : report from the National Cancer Database. Bone Joint J 2021; 103-B:1142-1149. [PMID: 34058874 DOI: 10.1302/0301-620x.103b6.bjj-2020-2087.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. METHODS We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI. RESULTS Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI. CONCLUSION A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142-1149.
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Affiliation(s)
- Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohiro Fujiwara
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
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Blay JY, Boucher S, Le Vu B, Cropet C, Chabaud S, Perol D, Barranger E, Campone M, Conroy T, Coutant C, De Crevoisier R, Debreuve-Theresette A, Delord JP, Fumoleau P, Gentil J, Gomez F, Guerin O, Jaffré A, Lartigau E, Lemoine C, Mahe MA, Mahon FX, Mathieu-Daude H, Merrouche Y, Penault-Llorca F, Pivot X, Soria JC, Thomas G, Vera P, Vermeulin T, Viens P, Ychou M, Beaupere S. Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open 2021; 6:100134. [PMID: 33984676 PMCID: PMC8134718 DOI: 10.1016/j.esmoop.2021.100134] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
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Affiliation(s)
- J Y Blay
- Centre Leon Berard, Lyon, France.
| | | | | | - C Cropet
- Centre Leon Berard, Lyon, France
| | | | - D Perol
- Centre Leon Berard, Lyon, France
| | | | - M Campone
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | - T Conroy
- Institut de Cancerologie de Lorraine, Nancy, France
| | - C Coutant
- Centre George Francoise Leclerc, Dijon, France
| | | | | | - J P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - J Gentil
- Centre George Francoise Leclerc, Dijon, France
| | - F Gomez
- Centre Leon Berard, Lyon, France
| | - O Guerin
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | | | | | - C Lemoine
- Institut Paoli-Calmettes, Marseille, France
| | - M A Mahe
- Centre François Baclesse, Caen, France
| | | | - H Mathieu-Daude
- Institut de Cancerologie de Montpellier, Montpellier, France
| | | | | | - X Pivot
- Centre Paul Strauss/ICANS, Strasbourg, France
| | | | - G Thomas
- Centre François Baclesse, Caen, France
| | - P Vera
- Centre Henri Becquerel, Rouen, France
| | | | - P Viens
- Institut Paoli-Calmettes, Marseille, France
| | - M Ychou
- Institut de Cancerologie de Montpellier, Montpellier, France
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Bissonnette JP, Sun A, Grills IS, Almahariq MF, Geiger G, Vogel W, Sonke JJ, Everitt S, Manus MM. Non-small cell lung cancer stage migration as a function of wait times from diagnostic imaging: A pooled analysis from five international centres. Lung Cancer 2021; 155:136-143. [PMID: 33819859 DOI: 10.1016/j.lungcan.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with non-small cell lung cancer (NSCLC) can experience rapid disease progression between initial staging FDG-PET scans and commencement of curative-intent radiotherapy (RT). Previous studies that estimated stage migration rates by comparing staging PET/CT and treatment-planning PET/CT images were limited by small sample sizes. METHODS This multicenter, international study combined prospective data from five institutions for PET-staged patients with NSCLC who were intended to receive curative-intent RT. TNM status was compared for staging and RT planning scans and the probability of TNM status and overall stage migration was analyzed as a function of the interval between PET/CT scans. The impacts of N classification, overall stage, and pathology were also studied. RESULTS Pooled data from 181 patients were analyzed. The median interval between PET/CT scans was 42 days (range, 2-208). Upstaging occurred in 32 % of patients. The overall rate of stage migration was higher for patients presenting with initial stage IIIB/IIIC disease (p = 0.006) and patients with N2-3 nodal disease (p = 0.019). Upstaging to M1 disease was significantly associated with initial stage IIIB/IIIC disease (HR = 15.2) and adenocarcinoma (HR = 10) histology. CONCLUSION Longer intervals between imaging and treatment in patients with NSCLC were associated with high rates disease progression with consequent risks of geographic miss in RT planning and futile treatment in patients with M1 disease. Patients with more extensive initial nodal involvement and those with adenocarcinoma had the highest rates of stage migration. Dedicated RT planning PET/CT imaging is recommended, especially if >3 weeks have elapsed after initial staging.
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Affiliation(s)
- Jean-Pierre Bissonnette
- Department of Medical Physics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology and Department of Medical Biophysics, University of Toronto, Techna Institute, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Radiation Oncology, Toronto, Ontario, Canada. https://twitter.com/@JeanPierreBiss2
| | - Alexander Sun
- Department of Radiation Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Radiation Oncology, Toronto, Ontario, Canada
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Hospitals, Royal Oak, MI, United States
| | - Muayad F Almahariq
- Department of Radiation Oncology, Beaumont Hospitals, Royal Oak, MI, United States
| | - Geoffrey Geiger
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Wouter Vogel
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sarah Everitt
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael Mac Manus
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Does Delaying Time in Cancer Treatment Affect Mortality? A Retrospective Cohort Study of Korean Lung and Gastric Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073462. [PMID: 33810467 PMCID: PMC8036321 DOI: 10.3390/ijerph18073462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
The aim of this study is to investigate the association between delays in surgical treatment and five- and one- year mortality in patients with lung or gastric cancer. The National Health Insurance claims data from 2006 to 2015 were used. The association between time to surgical treatment, in which the cut-off value was set at average time (30 or 50 days), and five year mortality was analyzed using the Cox proportional hazard model. Subgroup analysis was performed based on treatment type and location of medical institution. A total of 810 lung and 2659 gastric cancer patients were included, in which 74.8% of lung and 71.2% of gastric cancer patients received surgery within average. Compared to lung cancer patients who received treatment within 50 days, the five-year (HR 1.826, 95% CI 1.437–2.321) mortality of those who received treatment afterwards was higher. The findings were not significant for gastric cancer based on the after 30 days standard (HR: 1.003, 95% CI: 0.822–1.225). In lung cancer patients, time-to-treatment and mortality risk were significantly different depending on region. Delays in surgical treatment were associated with mortality in lung cancer patients. The findings imply the importance of monitoring and assuring timely treatment in lung cancer patients.
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Shakeel S, Dhanoa M, Khan O, Dibajnia P, Akhtar-Danesh N, Behzadi A. Wait times in the management of non-small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis. Can J Surg 2021; 64:E218-E227. [PMID: 33769006 PMCID: PMC8064257 DOI: 10.1503/cjs.013319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Saad Shakeel
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
| | - Mankeeran Dhanoa
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
| | - Omar Khan
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
| | - Pooya Dibajnia
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
| | - Noori Akhtar-Danesh
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
| | - Abdollah Behzadi
- From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi)
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Walter AL, Baty F, Rassouli F, Bilz S, Brutsche MH. Diagnostic precision and identification of rare diseases is dependent on distance of residence relative to tertiary medical facilities. Orphanet J Rare Dis 2021; 16:131. [PMID: 33745447 PMCID: PMC7983389 DOI: 10.1186/s13023-021-01769-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnostic precision and the identification of rare diseases is a daily challenge, which needs specialized expertise. We hypothesized, that there is a correlation between the distance of residence to the next tertiary medical facility with highly specialized care and the diagnostic precision, especially for rare diseases. RESULTS Using a nation-wide hospitalization database, we found a negative association between diagnostic diversity and travel time to the next tertiary referral hospital when including all cases throughout the overall International Classification of Diseases version 10 German Modification (ICD-10-GM) diagnosis codes. This was paralleled with a negative association of standardized incidence rates in all groups of rare diseases defined by the Orphanet rare disease nomenclature, except for rare teratologic and rare allergic diseases. CONCLUSION Our findings indicate a higher risk of being mis-, under- or late diagnosed especially in rare diseases when living more distant to a tertiary medical facility. Greater distance to the next tertiary medical facility basically increases the chance for hospitalization in a non-comprehensive regional hospital with less diagnostic capacity, and, thus, impacts on adapted health care access. Therefore, solutions for overcoming the distance to specialized care as an indicator of health care access are a major goal in the future.
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Affiliation(s)
- Anna-Lena Walter
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Frank Rassouli
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Stefan Bilz
- Center for Rare Diseases of Eastern Switzerland (ZSK-O), Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Martin Hugo Brutsche
- Lung Center, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
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Improvement of EGFR Testing over the Last Decade and Impact of Delaying TKI Initiation. ACTA ACUST UNITED AC 2021; 28:1045-1055. [PMID: 33652831 PMCID: PMC8025752 DOI: 10.3390/curroncol28020102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 06/26/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background: Epidermal growth factor receptor (EGFR) is the most common oncogenic mutation in lung adenocarcinoma and tyrosine kinase inhibitors (TKIs) have been considered standard treatment for more than a decade. However, time to initiation of TKIs (TTIT) from diagnosis is often delayed and represents a challenge for clinicians. We aimed to assess the impact of TTIT on clinical outcomes and complications. Method: TTIT was defined as the time between confirmed advanced diagnosis and the initiation of a TKI. Complications during this pre-TKI period were retrospectively collected from all patients with EGFR-mutant non small cell lung cancer (NSCLC) in our institution. Results: 102 patients were diagnosed with EGFR mutated NSCLC between 2006 and 2019. The median PFS and OS were 12.9 and 22.5 months, respectively. TTIT was 5.7 months (95% CI 3.4–8) with a significant decrease in the latter years of this cohort. During the pre-TKI period, 23 patients received chemotherapy as first line treatment, of which 5 developed severe adverse events and 3 were not fit to receive TKI thereafter. Additionally, 29 patients had rapid clinical deterioration before initiation of first line TKI and 16 had to be hospitalized. Among the patients presenting a performance status deterioration, their prognosis was markedly affected compared to the remainder of the cohort (p = 0.01). Conclusion: Our real-world evidence study supports the concept that a delay to treat EGFR mutant NSCLC with TKIs is associated with adverse events, patient progression, hospitalization, and decreased overall survival. Rapid molecular diagnosis, including access to ctDNA technology may circumvent these deleterious delays.
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Pathy S, Thimmarayappa A, Malik P, Mallick S, Upadhyay A. Treatment outcomes and prognostic factors in locally advanced non-small cell lung cancer – An experience from normal India. J Cancer Res Ther 2021; 18:27-32. [DOI: 10.4103/jcrt.jcrt_1855_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cone EB, Marchese M, Paciotti M, Nguyen DD, Nabi J, Cole AP, Molina G, Molina RL, Minami CA, Mucci LA, Kibel AS, Trinh QD. Assessment of Time-to-Treatment Initiation and Survival in a Cohort of Patients With Common Cancers. JAMA Netw Open 2020; 3:e2030072. [PMID: 33315115 PMCID: PMC7737088 DOI: 10.1001/jamanetworkopen.2020.30072] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022] Open
Abstract
Importance Resource limitations because of pandemic or other stresses on infrastructure necessitate the triage of time-sensitive care, including cancer treatments. Optimal time to treatment is underexplored, so recommendations for which cancer treatments can be deferred are often based on expert opinion. Objective To evaluate the association between increased time to definitive therapy and mortality as a function of cancer type and stage for the 4 most prevalent cancers in the US. Design, Setting, and Participants This cohort study assessed treatment and outcome information from patients with nonmetastatic breast, prostate, non-small cell lung (NSCLC), and colon cancers from 2004 to 2015, with data analyzed January to March 2020. Data on outcomes associated with appropriate curative-intent surgical, radiation, or medical therapy were gathered from the National Cancer Database. Exposures Time-to-treatment initiation (TTI), the interval between diagnosis and therapy, using intervals of 8 to 60, 61 to 120, 121 to 180, and greater than 180 days. Main Outcomes and Measures 5-year and 10-year predicted all-cause mortality. Results This study included 2 241 706 patients (mean [SD] age 63 [11.9] years, 1 268 794 [56.6%] women, 1 880 317 [83.9%] White): 1 165 585 (52.0%) with breast cancer, 853 030 (38.1%) with prostate cancer, 130 597 (5.8%) with NSCLC, and 92 494 (4.1%) with colon cancer. Median (interquartile range) TTI by cancer was 32 (21-48) days for breast, 79 (55-117) days for prostate, 41 (27-62) days for NSCLC, and 26 (16-40) days for colon. Across all cancers, a general increase in the 5-year and 10-year predicted mortality was associated with increasing TTI. The most pronounced mortality association was for colon cancer (eg, 5 y predicted mortality, stage III: TTI 61-120 d, 38.9% vs. 181-365 d, 47.8%), followed by stage I NSCLC (5 y predicted mortality: TTI 61-120 d, 47.4% vs 181-365 d, 47.6%), while survival for prostate cancer was least associated (eg, 5 y predicted mortality, high risk: TTI 61-120 d, 12.8% vs 181-365 d, 14.1%), followed by breast cancer (eg, 5 y predicted mortality, stage I: TTI 61-120 d, 11.0% vs. 181-365 d, 15.2%). A nonsignificant difference in treatment delays and worsened survival was observed for stage II lung cancer patients-who had the highest all-cause mortality for any TTI regardless of treatment timing. Conclusions and Relevance In this cohort study, for all studied cancers there was evidence that shorter TTI was associated with lower mortality, suggesting an indirect association between treatment deferral and mortality that may not become evident for years. In contrast to current pandemic-related guidelines, these findings support more timely definitive treatment for intermediate-risk and high-risk prostate cancer.
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Affiliation(s)
- Eugene B. Cone
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maya Marchese
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marco Paciotti
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - David-Dan Nguyen
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Junaid Nabi
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alexander P. Cole
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - George Molina
- Division of Surgical Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rose L. Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christina A. Minami
- Division of Breast Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
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Wah W, Stirling RG, Ahern S, Earnest A. Influence of timeliness and receipt of first treatment on geographic variation in non-small cell lung cancer mortality. Int J Cancer 2020; 148:1828-1838. [PMID: 33045098 DOI: 10.1002/ijc.33343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/31/2022]
Abstract
Mortality from non-small cell lung cancer (NSCLC) exhibits substantial geographical disparities. However, there is little evidence on whether this variation could be attributed to patients' clinical characteristics and/or socioeconomic inequalities. This study evaluated the independent and relative contribution of the individual- and area-level risk factors on geographic variation in 2-year all-cause mortality among NSCLC patients. In the Hierarchical-related regression approach, we used the Bayesian spatial multilevel logistic regression model to combine individual- and area-level predictors with outcomes while accounting for geographically structured and unstructured correlation. Individual-level data included 3330 NSCLC cases reported to the Victoria Lung Cancer Registry between 2011 and 2016. Area-level data comprised socioeconomic disadvantage, remoteness and pollution data at the postal area level in Victoria, Australia. With the inclusion of significant individual- and area-level risk factors, timely (≤14 days) first definitive treatment (odds ratio [OR] = 0.73, 95% credible interval [Crl] = 0.56-0.94) and multidisciplinary meetings (MDM) (OR = 0.74, 95% Crl = 0.59-0.93) showed an independent association with a lower likelihood of NSCLC 2-year all-cause mortality. Timely and delayed (>14 days) first nondefinitive treatment, no treatment, advanced clinical stage, smoking, poor performance status, public hospital insurance and area-level deprivation were independently associated with a higher likelihood of 2- and 5-year all-cause mortality. NSCLC's 2-year all-cause mortality exhibited substantial geographic variation, mainly associated with timeliness and receipt of first definitive treatment, no treatment followed by patient prognostic factors with some contribution from area-level deprivation, MDM and public hospital insurance. This study highlights NSCLC patients should receive the first definitive treatment within the recommended 14-days from diagnosis.
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Affiliation(s)
- Win Wah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rob G Stirling
- Department of Allergy, Immunology & Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Cushman TR, Jones B, Akhavan D, Rusthoven CG, Verma V, Salgia R, Sedrak M, Massarelli E, Welsh JW, Amini A. The Effects of Time to Treatment Initiation for Patients With Non-small-cell Lung Cancer in the United States. Clin Lung Cancer 2020; 22:e84-e97. [PMID: 33039348 DOI: 10.1016/j.cllc.2020.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 07/31/2020] [Accepted: 09/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to determine the effects of time from diagnosis to treatment (TTI) on survival in patients with nonmetastatic non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS The National Cancer Database was queried for patients with stages 1 to 3 NSCLC between 2004 and 2013. Patients with missing survival status/time, unknown TTI, or receipt of palliative therapy were excluded. Multivariable Cox proportional hazards modeling, logistic regression, and recursive partitioning analysis were performed to determine associated variables and survival outcomes. RESULTS Altogether, 1,393,232 patients met inclusion criteria. The median follow-up was 36 months. The median TTI increased between 2004 and 2013 from 35 to 39 days (P < .001). On multivariable Cox proportional hazards modeling, TTI groups 31 to 60 days, 61 to 90 days, and > 90 days were independently related to poorer overall survival (OS) compared with TTI 1 to 30 days (hazard ratio, 1.04, 1.10, and 1.14; 95% confidence interval [CI], 1.02-1.06, 1.07-1.12, and 1.11-1.17, respectively; P < .001 for all). Recursive partitioning analysis revealed that TTI of ≤ 45 days was the most optimal threshold for survival (P < .001); patients with TTI ≤ 45 days had a median OS of 70.2 months (95% CI, 69.3-71.1 months) versus 61.5 months (95% CI, 60.5-62.4) (P < .001). There were significant disparities by age, race, ethnicity, and income for delayed (> 45 days) TTI (P < .001 for all). Subgroup analysis revealed that stage 1 and 2 patients with TTI > 45 days had a higher risk of mortality compared with TTI ≤ 45 days (hazard ratio, 1.15 and 1.05; 95% CI, 1.12-1.17 and 1.01-1.09, respectively) (P < .001). CONCLUSIONS Increased TTI is independently associated with poorer survival in non-metastatic NSCLC. TTI ≤ 45 days is a clinically targetable time frame associated with improved outcomes and ought to be considered for patients with lung cancer undergoing definitive therapy.
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Affiliation(s)
- Taylor R Cushman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO
| | - David Akhavan
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ravi Salgia
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Mina Sedrak
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Erminia Massarelli
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
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de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Ning MS, Palmer MB, Shah AK, Chambers LC, Garlock LB, Melson BB, Frank SJ. Three-Year Results of a Prospective Statewide Insurance Coverage Pilot for Proton Therapy: Stakeholder Collaboration Improves Patient Access to Care. JCO Oncol Pract 2020; 16:e966-e976. [PMID: 32302271 PMCID: PMC8462618 DOI: 10.1200/jop.19.00437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Proton therapy is increasingly prescribed, given its potential to improve outcomes; however, prior authorization remains a barrier to access and is associated with frequent denials and treatment delays. We sought to determine whether appropriate access to proton therapy could ensure timely care without overuse or increased costs. METHODS Our large academic cancer center collaborated with a statewide self-funded employer (n = 186,000 enrollees) on an insurance coverage pilot, incorporating a value-based analysis and ensuring preauthorization for appropriate indications. Coverage was ensured for prospective trials and five evidence-supported anatomic sites. Enrollment initiated in 2016 and continued for 3 years. Primary end points were use, authorization time, and cost of care, with case-matched comparison of total charges at 1 month pretreatment through 6 months posttreatment. RESULTS Thirty-two patients were approved over 3 years, with only 22 actually receiving proton therapy, versus a predicted use by 120 patients (P < .01). Median follow-up was 20.1 months, and average authorization time decreased from 17 days to < 1 day (P < .01), significantly enhancing patient access. During this time, 25 patients who met pilot eligibility were instead treated with photons; and 17 patients with > 6 months of follow-up were case matched by treatment site to 17 patients receiving proton therapy, with no significant differences in sex, age, performance status, stage, histology, indication, prescribed fractions, or chemotherapy. Total medical costs (including radiation therapy [RT] and non-RT charges) for patients treated with PBT were lower than expected (a cost increase initially was expected), with no significant difference in total average charges (P = .82), in the context of overall ancillary care use. CONCLUSION This coverage pilot demonstrated that appropriate access to proton therapy does not necessitate overuse or significantly increase comprehensive medical costs. Objective evidence-based coverage polices ensure appropriate patient selection. Stakeholder collaboration can streamline patient access while reducing administrative burden.
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Affiliation(s)
- Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Laura C. Chambers
- Office of Employee Benefits, The University of Texas System, Austin, TX
| | - Laura B. Garlock
- Office of Employee Benefits, The University of Texas System, Austin, TX
| | - Benjamin B. Melson
- Department of Financial Planning and Analysis, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Proton Therapy Center, The University of Texas MD Anderson Cancer Center, Houston, TX
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50
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Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F, Eapen G, Caroff DA, Stevens MP, Ouellette DR, Lilly C, Gardner DD, Glisinski K, Pennington K, Alalawi R. The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest 2020; 158:1268-1281. [PMID: 32361152 PMCID: PMC7252059 DOI: 10.1016/j.chest.2020.04.036] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/19/2020] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs. STUDY DESIGN AND METHODS A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process. RESULTS The systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements. INTERPRETATION The evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.
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Affiliation(s)
- Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC.
| | - Samira Shojaee
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Virginia Commonwealth University, Richmond, VA
| | - Carla R Lamb
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Lahey Hospital and Medical Center, Burlington, MA
| | - David Ost
- Department of Medicine, Division of Pulmonary and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Fabien Maldonado
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University, Nashville, TN
| | - George Eapen
- Department of Medicine, Division of Pulmonary and Critical Care, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Caroff
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Lahey Hospital and Medical Center, Burlington, MA
| | - Michael P Stevens
- Department of Medicine, Divisions of Pulmonary and Critical Care and Infectious Disease, Virginia Commonwealth University, Richmond, VA
| | - Daniel R Ouellette
- Department of Medicine, Division of Pulmonary and Critical Care, Henry Ford Health System, Detroit, MI
| | - Craig Lilly
- Department of Medicine, Division of Pulmonary and Critical Care, University of Massachusetts, Worcester, MA
| | - Donna D Gardner
- Department of Respiratory Care, Texas State University, Round Rock, TX
| | - Kristen Glisinski
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC
| | - Kelly Pennington
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN
| | - Raed Alalawi
- Department of Medicine, Division of Pulmonary and Critical Care, University of Arizona, Phoenix, AZ
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