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Nduaguba SO, Kelly KM. Multilevel factors associated with delays in screening, diagnosis, and treatment for lung cancer-A mixed methods systematic review protocol. PLoS One 2024; 19:e0309196. [PMID: 39392844 PMCID: PMC11469495 DOI: 10.1371/journal.pone.0309196] [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: 05/18/2023] [Accepted: 08/06/2024] [Indexed: 10/13/2024] Open
Abstract
BACKGROUND Factors affecting time to lung cancer care may occur at multiple levels of influence. Mixed-methods reviews provide an approach for collectively synthesizing both quantitative and qualitative data. Prior reviews on timeliness of lung cancer care have included only either quantitative or qualitative data, been agnostic of the multilevel nature of influencing factors, or focused on a single factor such as gender or socioeconomic inequalities. OBJECTIVE We aimed to update the literature on systematic reviews and identify multilevel factors associated with delays in lung cancer screening, diagnosis, and treatment. DESIGN The proposed systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis specific for mixed methods systematic reviews. Reporting will be consistent with PRISMA guidelines. METHODS Medline (PubMed), CINAHL, and SCOPUS will be searched using validated search terms for lung cancer and factors, health disparities and time/delay. Eligible studies will include original articles with quantitative, qualitative, or mixed-methods designs that investigate health disparities in, risk factors for, or barriers to timely screening, confirmatory diagnosis, or treatment among patients with lung cancer or those at risk for lung cancer. Title, abstract, and full-text screening, study quality assessment, and data extraction will be conducted by two reviewers. A convergent integrated approach with thematic synthesis will be applied to synthesize the extracted and generated analytical themes. DISCUSSION Findings from this review will inform the design of an intervention to address delays in lung cancer screening for high-risk persons, diagnosis of suspected lung cancer, and treatment of confirmed cases.
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Affiliation(s)
- Sabina O. Nduaguba
- Department of Pharmaceutical Systems and Policy, College of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
- West Virginia University Cancer Institute, Morgantown, West Virginia, United States of America
| | - Kimberly M. Kelly
- Department of Pharmaceutical Systems and Policy, College of Pharmacy, West Virginia University, Morgantown, West Virginia, United States of America
- West Virginia University Cancer Institute, Morgantown, West Virginia, United States of America
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Factors influencing the timeliness of care for patients with lung cancer in Bangladesh. BMC Health Serv Res 2023; 23:261. [PMID: 36927788 PMCID: PMC10018894 DOI: 10.1186/s12913-023-09154-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND This study explored the factors associated with timeliness of care in the healthcare seeking pathway among patients with lung cancer in Bangladesh. METHODS A structured questionnaire was used for data collection from 418 patients with lung cancer through face-to-face interviews in three tertiary care hospitals. Log-rank tests were performed to test differences in the length of intervals between points in healthcare by socioeconomic characteristics and care seeking behaviours of the patients. Cox Proportional Hazard (PH) regression analysis was performed to identify the predictors of the intervals after adjustment for variations in other variables. RESULTS A higher education level was associated significantly (p < 0.05) with a shorter interval between first contact with a healthcare provider (HCP) and diagnosis (median 81 days) and initiation of treatment (median 101 days). Higher monthly household income was associated significantly with a shorter time from first contact and diagnosis (median 91 days), onset of symptom and diagnosis (median 99 days), onset of symptom and treatment (median 122 days), and first contact with any HCP to treatment (median 111 days). Consulting with additional HCPs prior to diagnosis was associated significantly with longer intervals from first contact with any HCP and diagnosis (median 127 days), onset of symptom and diagnosis (median 154 days), onset of symptom and treatment (median 205 days), and first contact with any HCP to treatment (median 174 days). Consulting with informal HCPs was associated significantly with a longer time interval from symptom to treatment (median 171 days). Having more than one triggering symptom was associated significantly with a shorter interval between onset of symptoms and first contact with any HCP. CONCLUSION The predictors for timeliness of lung cancer care used in this study affected different intervals in the care seeking pathway. Higher education and income predicted shorter intervals whereas consulting informal healthcare providers and multiple providers were associated with longer intervals.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, 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, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, 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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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: 5.3] [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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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Defining timeliness in care for patients with lung cancer: a scoping review. BMJ Open 2022; 12:e056895. [PMID: 35393318 PMCID: PMC8990712 DOI: 10.1136/bmjopen-2021-056895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/11/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer. METHODS This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles. RESULTS A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure. CONCLUSION This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, 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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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: 9] [Impact Index Per Article: 2.3] [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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Mou B, Hyde D, Araujo C, Bartha L, Bergman A, Liu M. Implementation of Single-Fraction Lung Stereotactic Ablative Radiotherapy in a Multicenter Provincial Cancer Program During the COVID-19 Pandemic. Cureus 2021; 13:e15598. [PMID: 34277219 PMCID: PMC8270065 DOI: 10.7759/cureus.15598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background During the novel coronavirus disease 2019 (COVID-19) pandemic, cancer centers considered shortened courses of radiotherapy to minimize the risk of infectious exposure of patients and staff members. Amidst a pandemic, the process of implementing new treatment approaches can be particularly challenging in larger institutions with multiple treatment centers. We describe the implementation of single-fraction (SF) lung stereotactic ablative radiotherapy (SABR) in a multicenter provincial cancer program. Materials and Methods British Columbia, Canada has a provincial cancer program with six geographically distributed radiotherapy centers serving a population of 5.1 million, over 944,735 square kilometers. In March 2020, provincial mitigation strategies were developed in case of reduced access to radiotherapy due to the COVID-19 pandemic. SF lung SABR was identified by the provincial lung radiation oncology group as a mitigation measure supported by high-quality randomized evidence that could provide comparable outcomes and toxicity to existing fractionated SABR protocols. A working group consisting of radiation oncologists and medical physicists reviewed the medical literature and drafted consensus guidelines that were reviewed by a group of center representatives as a component of provincial lung radiotherapy mitigation strategic planning. Individual centers were encouraged to implement SF lung SABR as their resources and staffing would allow. Centers were then surveyed about barriers to implementation. Results On March 24, 2020, a working group was created and consensus guidelines for SF lung SABR were drafted. The final version was approved and distributed by the working group on March 26, 2020. The provincial lung radiotherapy mitigation strategy group adopted the guidelines for implementation on April 1, 2020. Implementation was completed at the first center on April 27, 2020. Barriers to implementation were identified at five of six centers. Two centers in regions with disproportionately high COVID-19 cases described inadequate staffing as a barrier to implementation. One center encountered delays due to pre-scheduled commissioning of new treatment techniques. Three centers cited competing priorities as reasons for delay. As of May 2021, two centers had active SF lung SABR programs in place, three centers were in the process of implementation, and one center had no immediate plans for implementation due to ongoing resource issues. Conclusion SF lung SABR was adopted by a provincial cancer program within weeks of conception through rapid communication during the development of COVID-19 pandemic mitigation strategies for radiotherapy. Although consensus guidelines were written and approved in an expedited timeframe, the completion of implementation by individual centers was variable due to differences in resource allocation and staffing among the centers. Strong organizational structures and early identification of potential barriers may improve the efficiency of implementing new treatment initiatives in large multicenter radiotherapy programs.
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Affiliation(s)
- Benjamin Mou
- Radiation Oncology, BC Cancer Kelowna, Kelowna, CAN
| | - Derek Hyde
- Medical Physics, BC Cancer Kelowna, Kelowna, CAN
| | | | - Leigh Bartha
- Radiation Therapy, BC Cancer Kelowna, Kelowna, CAN
| | | | - Mitchell Liu
- Radiation Oncology, BC Cancer Vancouver, Vancouver, CAN
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Curtis GL, Lawrenz JM, George J, Styron JF, Scott J, Shah C, Shepard DR, Rubin B, Nystrom LM, Mesko NW. Adult soft tissue sarcoma and time to treatment initiation: An analysis of the National Cancer Database. J Surg Oncol 2018; 117:1776-1785. [DOI: 10.1002/jso.25095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/16/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Gannon L. Curtis
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | | | - Jaiben George
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Joe F. Styron
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Jacob Scott
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | - Chirag Shah
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | | | - Brian Rubin
- Department of Pathology; Cleveland Clinic; Cleveland Ohio
| | - Lukas M. Nystrom
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
| | - Nathan W. Mesko
- Department of Orthopaedic Surgery; Cleveland Clinic; Cleveland Ohio
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Jacobsen MM, Silverstein SC, Quinn M, Waterston LB, Thomas CA, Benneyan JC, Han PKJ. Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review. Lung Cancer 2017; 112:156-164. [PMID: 29191588 DOI: 10.1016/j.lungcan.2017.08.011] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/18/2022]
Abstract
The Institute of Medicine recently called for increased understanding of and commitment to timely care. Lung cancer can be difficult to diagnose, resulting in delays that may adversely affect survival; rapid diagnosis and treatment therefore is critical for enabling improved patient outcomes. This scoping review provides an update on timeliness of lung cancer care over the past decade. We searched PubMed for English-language articles published from 2007 to 2016 that report wait time intervals related to diagnosis and treatment of lung cancer. Two authors independently reviewed titles and abstracts for inclusion. Abstracted data included sample size, patient population, study type, dates of study, wait times, and information on disparities, survival, costs, healthcare utilization, and interventions. The final review included 65 studies from 21 different countries. A total of 96 unique variations of wait intervals were reported (e.g., time to diagnosis from first pulmonologist visit, imaging, or initial evaluation), making comparisons across studies difficult. The most common interval was diagnosis to treatment initiation, with reported medians ranging from 6 to 45 days. Fourteen articles reported information on survival, 14 on healthcare utilization, 18 on disparities, and 14 on interventions; results varied by study. Significant variation exists in how access to care time delays are reported. Many patients across different facilities and countries appear to be facing substantial waits to receive lung cancer diagnosis and care. Further research, using common wait-interval metrics, is needed to evaluate and improve timeliness of lung cancer diagnosis and treatment.
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Affiliation(s)
- Margo M Jacobsen
- From the Healthcare Systems Engineering Institute, Northeastern University, Boston, MA, USA
| | - Sophie C Silverstein
- From the Healthcare Systems Engineering Institute, Northeastern University, Boston, MA, USA
| | - Michael Quinn
- Department of Radiology, Maine Medical Center, Portland, ME, USA; Spectrum Medical Group, Portland, ME, USA
| | - Leo B Waterston
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
| | | | - James C Benneyan
- From the Healthcare Systems Engineering Institute, Northeastern University, Boston, MA, USA.
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA
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Van de Vosse D, Chowdhury R, Boyce A, Halperin R. Wait Times Experienced by Lung Cancer Patients in the BC Southern Interior to Obtain Oncologic Care: Exploration of the Intervals from First Abnormal Imaging to Oncologic Treatment. Cureus 2015; 7:e330. [PMID: 26543688 PMCID: PMC4627838 DOI: 10.7759/cureus.330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/22/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Lung cancer is associated with rapid disease progression, which can significantly progress over a duration of four to eight weeks. This study examines the time interval lung cancer patients from the interior of British Columbia (BC) experience while undergoing diagnostic evaluation, biopsy, staging, and preparation for treatment. METHODS A chart review of lung cancer patients (n=231) referred to the BC Cancer Agency Centre for the Southern Interior between January 1, 2010 and December 31, 2011 was performed. Time zero was defined as the date of the first abnormal chest imaging. Time intervals, expressed as median averages, to specialist consult, biopsy, oncologic referral, initial oncology consultation, and commencement of oncologic treatment were obtained. RESULTS The median time interval from first abnormal chest imaging to a specialist consultation was 18 days (interquartile range, IQR, 7-36). An additional nine days elapsed prior to biopsy in the form of bronchoscopy, CT-guided biopsy, or sputum cytology (median; IQR, 3-21); if lobectomy was required, 18 days elapsed (median; IQR, 9-28). Eight days were required for pathologic diagnosis and subsequent referral to the cancer centre (median; IQR, 3-16.5). Once referral was received, 10 days elapsed prior to consultation with either a medical or radiation oncologist (median, IQR 5-18). Finally, eight days was required for initiation of radiation and/or chemotherapy (median; IQR, 1-15). The median wait time from detection of lung cancer on imaging to oncologic treatment in the form of radiation and/or chemotherapy was 65.5 days (IQR, 41.5-104.3). INTERPRETATION Patients in the BC Southern Interior experience considerable delays in accessing lung cancer care. During this time, the disease has the potential to significantly progress and it is possible that a subset of patients may lose their opportunity for curative intent treatment.
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Affiliation(s)
- David Van de Vosse
- Department of Radiation Oncology, BC Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior
| | - Rezwan Chowdhury
- Department of Radiation Oncology, BC Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior
| | - Andrew Boyce
- Department of Radiation Oncology, BC Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior
| | - Ross Halperin
- Department of Radiation Oncology, BC Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior
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Chalubinska-Fendler J, Fendler W, Spych M, Luniewska-Bury J, Mlynarski W, Fijuth J. Availability and outcomes of radiotherapy in Central Poland during the 2005-2012 period - an observational study. BMC Cancer 2015; 15:214. [PMID: 25884958 PMCID: PMC4389344 DOI: 10.1186/s12885-015-1236-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using a cross-database integrative approach, we performed an epidemiological analysis in a representative region of central Poland to evaluate the availability of radiotherapy (RTx) and overall survival of adult patients undergoing RTx for cancer. METHODS Epidemiological data on cancer incidence in the 2005-2012 period were obtained from the Nationwide Cancer Registry. Using data from the Ministry of Internal Affairs, we collected survival information of all patients treated in the only centre providing RTx for a region inhabited by approximately 2.6 million people. RESULTS After filtering out individuals on the basis of exclusion criteria, the final dataset covered 17,736 patients. Availability of RTx increased marginally, from 23.5% (2005) to 24.4% (2011, R = 0.39, p = 0.38), with the highest values noted in patients with cervical (78.5%), prostate (70.6%) and breast cancer (62.7%). However, due to the decreasing population of the region, we noted increasing disparity in the likelihood of receiving RTx depending on the patient's area of residence, with rural areas becoming progressively more neglected. The best prognosis was noted among patients with breast or prostate cancer with 5-year OS rates reaching 81.2% and 83.3%, respectively. Multivariate analysis controlling for type of diagnosis and patient age showed a time-dependent improvement in outcomes (HR(95% CI): 0.96(0.94-0.98); p < 0.0001). CONCLUSIONS Availability of RTx in Poland is still below that reported by developed European centres. Survival of patients undergoing radical RTx has gradually improved, although it is still below that of leading RTx departments, potentially due to delayed diagnosis or organisational barriers, necessitating further investigations.
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Affiliation(s)
| | - Wojciech Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland.
| | - Michal Spych
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
| | - Jolanta Luniewska-Bury
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
| | - Wojciech Mlynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Lodz, Poland.
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, 4 Paderewskiego Street, 93-509, Lodz, Poland.
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Noonan K, Tong KM, Laskin J, Melosky B, Sun S, Murray N, Ho C. Referral patterns in advanced non-small cell lung cancer: impact on delivery of treatment and survival in a contemporary population based cohort. Lung Cancer 2014; 86:344-9. [PMID: 25439436 DOI: 10.1016/j.lungcan.2014.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/16/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Chemotherapy improves overall survival (OS) in advanced non-small cell lung cancer (NSCLC), yet low rates of chemotherapy utilization have been observed. We sought to characterize the clinical effectiveness of chemotherapy in the general population by evaluating referral patterns, predictors of chemotherapy receipt and outcomes. METHODS All referred cases of stage IIIB/IV NSCLC in British Columbia from January 1 to December 31, 2009 were retrospectively reviewed. Patient demographics, tumor characteristics and treatments were extracted. OS was estimated using the Kaplan-Meier method. Cox Proportional Hazards modeling was used to control for confounding variables. Multiple logistic regression was used to assess factors that predicted for chemotherapy treatment. RESULTS 1373 patients were identified. Median age 70 years, 53% male, 37% ECOG ≥ 3. HISTOLOGY 34% non-squamous, 21% squamous and 46% NOS. 748 (54%) patients were assessed by medical oncology and 417 (30%) received chemotherapy. Predictors of chemotherapy treatment were younger age, ECOG 0-2, living in a rural area and not receiving radiotherapy. There was an improvement in OS in patients who received chemotherapy at 13.1 months versus best supportive care 5.4 months (p<0.0001). This remained statistically significant when controlling for ECOG, sex, age, histology (HR 0.68, CI 0.59-0.78). CONCLUSIONS In this population-based setting, 37% of patients had an ECOG ≥ 3 at the time of referral, 54% were assessed by a medical oncologist and only 30% received chemotherapy. This is despite the awareness that chemotherapy significantly improves survival. Strategies to optimize appropriate referral such that patients do not miss out on life-prolonging therapy should be evaluated.
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Affiliation(s)
- Krista Noonan
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - King Mong Tong
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - Janessa Laskin
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - Barbara Melosky
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - Sophie Sun
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - Nevin Murray
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada
| | - Cheryl Ho
- Department of Medical Oncology, BC Cancer Agency, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6 Canada.
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Ampil FL, Caldito G. Patient-provider delays in superior vena caval obstruction of lung cancer and outcomes. Am J Hosp Palliat Care 2014; 31:441-3. [PMID: 23728416 DOI: 10.1177/1049909113491622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This retrospective study investigates the types of delay in the initiation of palliative thoracic radiotherapy for superior vena caval obstruction (SVCO) of lung cancer (LCa) and the effect of treatment delay on patient outcomes. Treatment delays were categorized as patient delay (duration of symptoms), in-hospital delay, and professional delay and were determined in 42 people treated by radiation for palliation of the complicated neoplastic condition between 1981 and 2009. The median period of patient delay was 26.2 days, in-hospital delay was 3.5 days, and professional delay was 1.5 days. The majority (80%) of these individuals were uninsured or underinsured, and 69% presented with locally advanced LCa. The overall response rate was 84%, and the 1-year survival rate was 24%. Despite the longest patient-related delay, symptomatic individuals overall derived palliation from conventional treatment. Improved efforts toward early diagnosis and treatment of patients with SVCO-LCa need to be continued.
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Affiliation(s)
- Federico L Ampil
- 1Division of Therapeutic Radiology, Louisiana State University Health, Shreveport, LA, USA
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