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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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2
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Zhang Y, Simoff MJ, Ost D, Wagner OJ, Lavin J, Nauman B, Hsieh MC, Wu XC, Pettiford B, Shi L. Understanding the patient journey to diagnosis of lung cancer. BMC Cancer 2021; 21:402. [PMID: 33853552 PMCID: PMC8045203 DOI: 10.1186/s12885-021-08067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This research describes the clinical pathway and characteristics of two cohorts of patients. The first cohort consists of patients with a confirmed diagnosis of lung cancer while the second consists of patients with a solitary pulmonary nodule (SPN) and no evidence of lung cancer. Linked data from an electronic medical record and the Louisiana Tumor Registry were used in this investigation. Materials and methods REACHnet is one of 9 clinical research networks (CRNs) in PCORnet®, the National Patient-Centered Clinical Research Network and includes electronic health records for over 8 million patients from multiple partner health systems. Data from Ochsner Health System and Tulane Medical Center were linked to Louisiana Tumor Registry (LTR), a statewide population-based cancer registry, for analysis of patient’s clinical pathways between July 2013 and 2017. Patient characteristics and health services utilization rates by cancer stage were reported as frequency distributions. The Kaplan-Meier product limit method was used to estimate the time from index date to diagnosis by stage in lung cancer cohort. Results A total of 30,559 potentially eligible patients were identified and 2929 (9.58%) had primary lung cancer. Of these, 1496 (51.1%) were documented in LTR and their clinical pathway to diagnosis was further studied. Time to diagnosis varied significantly by cancer stage. A total of 24,140 patients with an SPN were identified in REACHnet and 15,978 (66.6%) had documented follow up care for 1 year. 1612 (10%) had no evidence of any work up for their SPN. The remaining 14,366 had some evidence of follow up, primarily office visits and additional chest imaging. Conclusion In both cohorts multiple biopsies were evident in the clinical pathway. Despite clinical workup, 70% of patients in the lung cancer cohort had stage III or IV disease. In the SPN cohort, only 66% were identified as receiving a diagnostic work-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08067-1.
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Affiliation(s)
- Yichen Zhang
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
| | - Michael J Simoff
- Bronchoscopy and Interventional Pulmonology, Lung Cancer Screening Program, Pulmonary & Critical Care Medicine, Henry Ford Hospital, Wayne State University School of Medicine, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - David Ost
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - James Lavin
- Intuitive, 1020 Kifer Road, Sunnyvale, CA, 94086, USA
| | - Beth Nauman
- Louisiana Public Health Institute, 1515 Poydras Street #1200, New Orleans, LA, 70112, USA
| | - Mei-Chin Hsieh
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Xiao-Cheng Wu
- Louisiana State University Health Science Center, 433 Bolivar St, New Orleans, LA, 70112, USA
| | - Brian Pettiford
- Ochsner Health System, 1514 Jefferson Highway, Jefferson, LA, 70121, USA
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA
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3
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Habbous S, Khan Y, Langer DL, Kaan M, Green B, Forster K, Darling G, Holloway CMB. The effect of diagnostic assessment programs on the diagnosis and treatment of patients with lung cancer in Ontario, Canada. Ann Thorac Med 2021; 16:81-101. [PMID: 33680129 PMCID: PMC7908893 DOI: 10.4103/atm.atm_283_20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs). METHODS Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients. RESULTS DAP patients were younger (P < 0.0001), had fewer comorbidities (P = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76-0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92-1.00]). A longer time until treatment was associated with better overall survival. CONCLUSION DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.
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Affiliation(s)
- Steven Habbous
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yasir Khan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Deanna L Langer
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Melissa Kaan
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Bo Green
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Katharina Forster
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Gail Darling
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Claire M B Holloway
- Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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4
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Schwartzberg LS, Horinouchi H, Chan D, Chernilo S, Tsai ML, Isla D, Escriu C, Bennett JP, Clark-Langone K, Svedman C, Tomasini P. Liquid biopsy mutation panel for non-small cell lung cancer: analytical validation and clinical concordance. NPJ Precis Oncol 2020; 4:15. [PMID: 32596507 PMCID: PMC7314769 DOI: 10.1038/s41698-020-0118-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 04/09/2020] [Indexed: 01/09/2023] Open
Abstract
Molecular testing for genomic variants is recommended in advanced non-small cell lung cancer (NSCLC). Standard tissue biopsy is sometimes infeasible, procedurally risky, or insufficient in tumor tissue quantity. We present the analytical validation and concordance study of EGFR variants using a new 17-gene liquid biopsy assay (NCT02762877). Of 144 patients enrolled with newly diagnosed or progressive stage IV nonsquamous NSCLC, 140 (97%) had liquid assay results, and 117 (81%) had both EGFR blood and tissue results. Alterations were detected in 58% of liquid samples. Overall tissue-liquid concordance for EGFR alterations was 94.0% (95% CI 88.1%, 97.6%) with positive percent agreement of 76.7% (57.7%, 90.1%) and negative percent agreement of 100% (95.8%, 100%). Concordance for ALK structural variants was 95.7% (90.1%, 98.6%). This assay detected alterations in other therapeutically relevant genes at a rate similar to tissue analysis. These results demonstrate the analytical and clinical validity of this 17-gene assay.
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Affiliation(s)
- Lee S. Schwartzberg
- West Cancer Center & Research Institute, 7945 Wolf River Boulevard, Germantown, TN 38138 USA
| | - Hidehito Horinouchi
- National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - David Chan
- Cancer Care Associates TMPN (now Hunt Cancer Center), 3285 Skypark Dr, Torrance, CA 90505 USA
| | - Sara Chernilo
- Instituto Nacional del Tórax, José Manuel Infante 717, segundo piso, Providencia, 7500691 Santiago, Chile
| | - Michaela L. Tsai
- Virginia Piper Cancer Institute, Minnesota Oncology, 800 E 28th St., Suite 602, Minneapolis, MN 55407 USA
| | - Dolores Isla
- University Hospital Lozano Blesa, Avda. S. Juan Bosco no 15, 50009 Zaragoza, Spain
| | - Carles Escriu
- The Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JK UK
| | - John P. Bennett
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Kim Clark-Langone
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Christer Svedman
- Genomic Health, Inc. (now Exact Sciences Corp.), 301 Penobscot Dr, Redwood City, CA 94063 USA
| | - Pascale Tomasini
- Assistance Publique Hôpitaux de Marseille, and Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Aix-Marseille Université, UM105 Marseille, France
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5
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Jazieh AR, Bounedjar A, Al Dayel F, Fahem S, Tfayli A, Rasul K, Jaafar H, Jaloudi M, Al Fayea T, Almaghrabi HQ, Bamefleh H, AlKattan K, Larbaoui B, Filalli T, Al Mistiri M, Alhusaini H. Patterns of diagnostic procedures for lung cancer pathology in the Middle East and North Africa. J Thorac Dis 2019; 11:5162-5168. [PMID: 32030233 DOI: 10.21037/jtd.2019.12.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Accurate pathological diagnosis is the first critical step in the management of lung cancer. This step is important to determine the histological subtype of the cancer and to identify any actionable targets. Our study aimed at evaluating the patterns of procedures used to obtain pathological diagnosis of lung cancer in the Middle East and North Africa (MENA) Region. Methods Data of consecutive patients with the diagnosis of non-small cell lung cancer (NSCLC) were collected from participating centers from different countries in the MENA Region. Methods of obtaining tissue diagnosis and workup were analyzed to determine the practice patterns of obtaining tissue diagnosis of lung cancer. Results A total of 566 patients were recruited from 10 centers in 5 countries including Saudi Arabia, United Arab Emirates (UAE), Qatar, Lebanon and Algeria. Majority of patients were males (78.1%) with a median age of 61 years (range, 22-89 years). Obtaining tissue diagnosis was successful in the first attempt in 72.3% of patients, while 16.4% and 6.3% of patients required 2nd and 3rd attempt, respectively. The success in first attempt was as follows: image guided biopsy (91%), surgical biopsy (88%), endobronchial biopsy (79%) and cytology (30%). The success in the second attempt was as follows; surgical biopsy (100%), image guided biopsy (95%), endobronchial biopsy (65%), cytology (25%). Conclusions More than quarter of the patients required repeated biopsy in the MENA Region. Image guided biopsy has the highest initial yield. Implementing clear process and multidisciplinary guidelines about the selection of diagnostic procedures is needed.
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Affiliation(s)
- Abdul Rahman Jazieh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Foad Al Dayel
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shamayel Fahem
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | | | | | - Turki Al Fayea
- Princess Noorah Oncology Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hatim Q Almaghrabi
- Princess Noorah Oncology Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hanaa Bamefleh
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khaled AlKattan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Blaha Larbaoui
- Department of Medical Oncology, Anti Cancer Center, Oran, Algeria
| | - Taha Filalli
- Department of Medical Oncology, CHU Constantine, Algeria
| | | | - Hamed Alhusaini
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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6
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Stokstad T, Sørhaug S, Amundsen T, Grønberg BH. Reasons for prolonged time for diagnostic workup for stage I-II lung cancer and estimated effect of applying an optimized pathway for diagnostic procedures. BMC Health Serv Res 2019; 19:679. [PMID: 31533705 PMCID: PMC6751647 DOI: 10.1186/s12913-019-4517-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/09/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Minimizing the time until start of cancer treatment is a political goal. In Norway, the target time for lung cancer is 42 days. The aim of this study was to identify reasons for delays and estimate the effect on the timelines when applying an optimal diagnostic pathway. METHODS Retrospective review of medical records of lung cancer patients, with stage I-II at baseline CT, receiving curative treatment (n = 100) at a regional cancer center in Norway. RESULTS Only 40% started treatment within 42 days. The most important delays were late referral to PET CT (n = 27) and exercise test (n = 16); repeated diagnostic procedures because bronchoscopy failed (n = 15); and need for further investigations after PET CT (n = 11). The time from referral to PET CT until the final report was 20.5 days in median. Applying current waiting time for PET CT (≤7 days), 48% would have started treatment within 42 days (p = 0.254). "Optimal pathway" was defined as 1) referral to PET CT and exercise test immediately after the CT scan and hospital visit, 2) tumor board discussion to decide diagnostic strategy and treatment, 3) referral to surgery or curative radiotherapy, 4) tissue sampling while waiting to start treatment. Applying the optimal pathway, current waiting time for PET CT and observed waiting times for the other procedures, 80% of patients could have started treatment within 42 days (p < 0.001), and the number of tissue sampling procedures could have been reduced from 112 to 92 (- 16%). CONCLUSION Changing the sequence of investigations would significantly reduce the time until start of treatment in curative lung cancer patients at our hospital and reduce the resources needed.
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Affiliation(s)
- Trine Stokstad
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway. .,Department of Gynecology, St. Olavs hospital, Trondheim University Hospital, PO Box 3250, Sluppen, NO-7006, Trondheim, Norway.
| | - Sveinung Sørhaug
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital, PO Box 3250, Sluppen, NO-7006, Trondheim, Norway
| | - Tore Amundsen
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs hospital, Trondheim University Hospital, PO Box 3250, Sluppen, NO-7006, Trondheim, Norway
| | - Bjørn H Grønberg
- Faculty of Medicine and Health Sciences, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, MTFS, NO-7491, Trondheim, Norway.,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, PO Box 3250, Sluppen, NO-7006, Trondheim, Norway
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7
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Lung cancer screening: Practice guidelines and insurance coverage are not enough. J Am Assoc Nurse Pract 2019; 31:33-45. [PMID: 30431549 DOI: 10.1097/jxx.0000000000000096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Low-dose computed tomography (LDCT) is expected to increase early detection of lung cancer and improve survival. The growth in the number of advanced nurse practitioners (NPs) in primary care settings increases the likelihood that an NP will serve as a patient's provider. This study's purpose was to examine knowledge, attitudes, and practices regarding LDCT among NPs who work in primary care settings. METHODS An explanatory, sequential, mixed-method design used a 32-item questionnaire, followed by a semi-structured telephone interview. The development of the survey and interview questions were guided by a conceptual framework representing a temporal sequence for behavior change and potential barriers to guideline adherence. CONCLUSIONS Nurse practitioners believe that shared decision making with their high-risk patients about LDCT is within their scope of their practice. Working in time-constrained primary care settings, NPs have limited abilities to improve the uptake of LDCT. Substantial patient barriers exist that deter follow through on providers' recommendation. Disseminating guidelines and authorizing health insurance reimbursement is insufficient. IMPLICATIONS FOR PRACTICE Research is needed that investigates the screening process so that barriers can be closely studied. Culture change is needed where early detection has greater value for insurers, providers, and patients.
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Leiro-Fernández V, Mouronte-Roibás C, García-Rodríguez E, Botana-Rial M, Ramos-Hernández C, Torres-Durán M, Ruano-Raviña A, Fernández-Villar A. Predicting delays in lung cancer diagnosis and staging. Thorac Cancer 2019; 10:296-303. [PMID: 30605236 PMCID: PMC6360216 DOI: 10.1111/1759-7714.12950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Despite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions. Methods We analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded. Results Malignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03). Conclusions A greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.
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Affiliation(s)
- Virginia Leiro-Fernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cecilia Mouronte-Roibás
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Esmeralda García-Rodríguez
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - María Torres-Durán
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Consortium for Biomedical Research in Epidemiology & Public Health, Galicia, Spain
| | - Alberto Fernández-Villar
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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Sampsonas F, Kakoullis L, Lykouras D, Karkoulias K, Spiropoulos K. EBUS: Faster, cheaper and most effective in lung cancer staging. Int J Clin Pract 2018; 72. [PMID: 29314425 DOI: 10.1111/ijcp.13053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/10/2017] [Indexed: 12/23/2022] Open
Abstract
The use of endobronchial ultrasound trans-bronchial needle aspiration (EBUS-TBNA) as the initial diagnostic and staging procedure in patients with suspected, non-metastatic lung cancer has gained substantial support, and is now recommended by numerous guidelines. Whereas considerable attention has been pointed to the reductions in costs achieved by EBUS-TBNA, that has not been the case for some of its more significant benefits, namely the reduction of the diagnostic work-up time and its ability to accurately assess and restage lymph nodes, which were previously stated incorrectly by CT or PET scan. Both these benefits translate into improved outcomes for patients, as delays are reduced, futile surgeries are prevented and curable operations can be performed on patients previously excluded by CT or PET scan. Indeed, the use of EBUS as the initial diagnostic and staging procedure has been proven to significantly increase survival, compared with conventional diagnostic and staging procedures, in a pragmatic, randomised controlled trial (Navani N. et al, 2015). The instalment of EBUS will have the greatest effect on overwhelmed, suboptimally functioning national healthcare systems, by decreasing the number of required diagnostic and staging procedures, therefore reducing both treatment delays and costs. The improved selection of surgical candidates by EBUS will result in improved patient outcomes. The latest findings regarding the benefits of EBUS are outlined in this review, which, to the best of our knowledge, is the first to emphasise the impact of the procedure, both on timing and costs of lung cancer staging, as well as on survival.
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Affiliation(s)
- Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Rion Patras, Greece
| | - Loukas Kakoullis
- Department of Respiratory Medicine, University Hospital of Patras, Rion Patras, Greece
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University Hospital of Patras, Rion Patras, Greece
| | - Kiriakos Karkoulias
- Department of Respiratory Medicine, University Hospital of Patras, Rion Patras, Greece
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Maiga AW, Deppen SA, Pinkerman R, Callaway-Lane C, Massion PP, Dittus RS, Lambright ES, Nesbitt JC, Baker D, Grogan EL. Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait? Ann Thorac Surg 2017; 104:1791-1797. [PMID: 29033012 PMCID: PMC5813822 DOI: 10.1016/j.athoracsur.2017.06.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Timely care of lung cancer is presumed critical, yet clear evidence of stage progression with delays in care is lacking. We investigated the reasons for delays in treatment and the impact these delays have on tumor-stage progression. METHODS We queried our retrospective database of 265 veterans who underwent cancer resection from 2005 to 2015. We extracted time intervals between nodule identification, diagnosis, and surgical resection; changes in nodule radiographic size over time; final pathologic staging; and reasons for delays in care. Pearson's correlation and Fisher's exact test were used to compare cancer growth and stage by time to treatment. RESULTS Median time from referral to surgical evaluation was 11 days (interquartile range, 8 to 17). Median time from identification to therapeutic resection was 98 days (interquartile range, 66 to 139), and from diagnosis to resection, 53 days (interquartile range, 35 to 77). Sixty-eight patients (26%) were diagnosed at resection; the remainder had preoperative tissue diagnoses. No significant correlation existed between tumor growth and time between nodule identification and resection, or between tumor growth and time between diagnosis and resection. Among 197 patients with preoperative diagnoses, 42% (83) had intervals longer than 60 days between diagnosis and resection. Most common reasons for delay were cardiac clearance, staging, and smoking cessation. Larger nodules had fewer days between identification and resection (p = 0.03). CONCLUSIONS Evaluation, staging, and smoking cessation drive resection delays. The lack of association between tumor growth and time to treatment suggests other clinical or biological factors, not time alone, underlie growth risk. Until these factors are identified, delays to diagnosis and treatment should be minimized.
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Affiliation(s)
- Amelia W Maiga
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen A Deppen
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Pierre P Massion
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert S Dittus
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric S Lambright
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan C Nesbitt
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee
| | - David Baker
- Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Eric L Grogan
- Tennessee Valley Healthcare System, Nashville, Tennessee; Vanderbilt University Medical Center, Nashville, Tennessee.
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11
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Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review. Lung Cancer 2017; 112:156-164. [DOI: 10.1016/j.lungcan.2017.08.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/18/2022]
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12
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Effectiveness of Bronchofiberoscopy in Diagnosis of Lung Lesions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017. [PMID: 28236122 DOI: 10.1007/5584_2017_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Lung cancer is the most common cause of cancer-related deaths. A short survival rate often results from belated diagnosis made in advanced stages. Therapy individualization requires the collection of a viable material for histopathological examination, which often brings difficulties. This study was performed in a group of 110 patients suspected of malignancy in chest computed tomography. All subjects underwent bronchofiberoscopy. Bronchoalveolar lavage (BAL) and endobronchial brushing were performed in all cases, whereas forceps tissue biopsy was taken if mucous membrane abnormalities were observed. In case of a negative result of bronchofiberoscopy invasive methods were implemented. A malignant neoplasm was diagnosed in 106 cases. Overall, cancer cells (positive result) were found in 45 patients (42.0%) subjected to bronchofiberoscopy. Cytology was positive in 38 (35.8%) and histopathological examination in 30 (28.3%) specimens. Eleven samples of BAL (10.3%) were positive. Endobronchial brushing was more effective, with 27 positive samples (25.5%). Forceps tissue biopsy was performed in 33 cases with 90% sensitivity. The most frequent cancer subtype found was squamous cell carcinoma. No severe complications of bronchofiberoscopy were observed. We conclude that bronchofiberosocpy is a safe diagnostic procedure for lung lesions, but its sensitivity and specificity are low. Only when there are mucous macroscopic changes observed, a precise diagnosis is possible.
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13
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Stokstad T, Sørhaug S, Amundsen T, Grønberg BH. Medical complexity and time to lung cancer treatment - a three-year retrospective chart review. BMC Health Serv Res 2017; 17:45. [PMID: 28095840 PMCID: PMC5240346 DOI: 10.1186/s12913-016-1952-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/15/2016] [Indexed: 05/29/2023] Open
Abstract
Background The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that ≥70% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35 days. However, delays can occur due to medical complexity. The aim of this study was to quantify the proportion of patients who started treatment within the recommended timeframes; and to assess the proportion of non-complex patients for which there were no good reasons for delays. Methods We performed a retrospective chart review of all patients diagnosed with lung cancer at a university hospital during 2011–2013. We defined “non-complex” patients as those who underwent ≤1 tissue diagnostic procedure and had no delays due to comorbidity, intercurrent disease or complications to diagnostic procedures (“Medical delays”) of more than three days. Results Four hundred forty-nine cases were analyzed; 142 (32%) had >1 tissue diagnostic procedures; 67 (15%) had medical delays >3 days; 262 (58%) were non-complex and 363 (81%) received treatment for lung cancer. Median number of days until surgery or radiotherapy was 48 (overall) and 41 (non-complex patients). The proportions who started surgery or radiotherapy within 42 days were 41% (overall) and 56% (non-complex). Corresponding numbers for systemic therapy were 29 days (overall) and 25 days (non-complex), and 64% (overall) and 80% (non-complex). Conclusion Fewer lung cancer patients than desired started treatment within the recommended timeframes. Even among the least complex patients, too few patients received timely treatment. The reasons need to be identified and understood, and changes in the organization appear to be necessary in order to offer timely treatment to more patients. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1952-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Trine Stokstad
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, N-7491, Trondheim, Norway. .,Department of Gynecology, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
| | - Sveinung Sørhaug
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Bjørn H Grønberg
- Department of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, PO Box 8905, N-7491, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
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14
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Verma A, Goh KS, Phua CK, Sim WY, Tee KS, Lim AY, Tai DY, Goh SK, Kor AC, Ho B, Lew SJ, Abisheganaden J. Diagnostic performance of convex probe EBUS-TBNA in patients with mediastinal and coexistent endobronchial or peripheral lesions. Medicine (Baltimore) 2016; 95:e5619. [PMID: 27977603 PMCID: PMC5268049 DOI: 10.1097/md.0000000000005619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
To compare the performance of convex probe endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) with conventional endobronchial biopsy (EBB) or transbronchial lung biopsy (TBLB) in patients with mediastinal, and coexisting endobronchial or peripheral lesions.Retrospective review of records of patients undergoing diagnostic EBUS-TBNA and conventional bronchoscopy in 2014.A total of 74 patients had mediastinal, and coexisting endobronchial or peripheral lesions. The detection rate of EBUS-TBNA for mediastinal lesion >1 cm in short axis, EBB for visible exophytic type of endobronchial lesion, and TBLB for peripheral lesion with bronchus sign were 71%, 75%, and 86%, respectively. In contrast, the detection rate of EBUS-TBNA for mediastinal lesion ≤1 cm in short axis, EBB for mucosal hyperemia type of endobronchial lesion, and TBLB for peripheral lesion without bronchus sign were 25%, 63%, and 38%, and improved to 63%, 88%, and 62% respectively by adding EBB or TBLB to EBUS-TBNA, and EBUS-TBNA to EBB or TBLB. Postprocedure bleeding was significantly more common in patients undergoing EBB and TBLB 8 (40%) versus convex probe EBUS-TBNA 2 patients (2.7%, P = 0.0004).EBUS-TBNA is a safer single diagnostic technique compared with EBB or TBLB in patients with mediastinal lesion of >1 cm in size, and coexisting exophytic type of endobronchial lesion, or peripheral lesion with bronchus sign. However, it requires combining with EBB or TBLB and vice versa to optimize yield when mediastinal lesion is ≤1 cm in size, and coexisting endobronchial and peripheral lesions lack exophytic nature, and bronchus sign, respectively.
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15
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Ozturk A, Demirci NY, Aktas Z, Demirag F, Alagoz A, Alici İO, Yilmaz A. EBUS may arise as an initial time saving procedure in patients who are suspected to have small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2016; 12:517-523. [PMID: 27704696 DOI: 10.1111/crj.12556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/12/2016] [Accepted: 08/29/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) commonly presents as hilar/mediastinal masses. In some occasions, conventional flexible bronchoscopy fails and a substantial amount of time is lost until establishing the diagnosis. OBJECTIVE The aim of the study was to demonstrate the superiority of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) compared to conventional methods in establishing the diagnosis as an initial modality as well as to point out the saved time until the diagnosis. METHODS We retrospectively reviewed the patients who were diagnosed as SCLC by EBUS-TBNA between April 2010 and January 2016. The demographics of the patients, smoking history were all recorded. We also compared the time between the first computed tomography (1stCT) and first diagnostic procedure (1stDP), 1stDP and final diagnosis (FDx), 1stCT and FDx, and 1stDP and EBUS procedure were also compared. RESULTS One hundred and thirty-three patients were included in the study. The diagnostic yield of EBUS-TBNA was 98.5%. The mean time between the 1stCT and 1stDP; 1stDP and FDx; 1stCT and FDx; 1stDP and EBUS procedure were 7.0 ± 9.0; 11.8 ± 16.1; 18.8 ± 17.9; and 10.8 ± 16.0 days, respectively. The time between 1stCT to 1stDP was not significantly different in patients with or without previous diagnostic procedures. However, the time between 1stDP to FDx and 1stCT to FDx were significantly higher in the patients with previous procedures (P < .001). The difference in time between 1stDP to FDx and 1stCT to FDx was also similar in patients with only hilar and/or mediastinal lesions (P = .001, P = .006, respectively). CONCLUSION EBUS-TBNA may be an initial diagnostic procedure in SCLC. Patients with only hilar/mediastinal masses without any endobronchial lesion could be directed to centers with the capability for performing EBUS-TBNA to have a rapid diagnosis without any time loss.
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Affiliation(s)
- Ayperi Ozturk
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Nilgun Yilmaz Demirci
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Zafer Aktas
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Funda Demirag
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ali Alagoz
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - İbrahim Onur Alici
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aydın Yilmaz
- Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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16
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Phua CK, Sim WY, Sen Tee K, Lew SJW, Lim AYH, Tai DYH, Goh SK, Kor AC, Ng AWK, Abisheganaden J, Verma A. Evaluation of pulmonary nodules in Asian population. J Thorac Dis 2016; 8:950-7. [PMID: 27162671 DOI: 10.21037/jtd.2016.03.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND American College of Chest Physicians (ACCP) provides guidelines to manage pulmonary nodules. Pulmonary nodules however can be malignant or benign. Similar incidence of tuberculosis (TB) and lung cancer in Asian countries raises concern over the relevance of suggested guidelines in Asian population. There is little data on the pattern of clinical practice in the management of pulmonary nodules in Asian country (Singapore). Our study describes the current pattern of clinical practice in this area highlighting the variation in practice and discussing the potential reasons. METHODS Retrospective review of the medical records of patients diagnosed with lung cancer in 2010. RESULTS Sixty nodules were identified in 32 patients. Nodules were detected incidentally on routine imaging in 7 (21.9%) patients. TB contact tracing and pre-employment screening were common ways by which nodules were detected incidentally. Over one third (37.5%) were non-smokers. Majority of nodules were located in the upper lobes of right and left lung followed by right lower lobe (RLL). Only few patients 8 (25%) had positron emission tomography (PET) scan for staging purposes. There were no difference in survival between patients who presented with single, 747 (range, 25-1,840) days vs. multiple nodules 928 (range, 30-2,572) days, P=0.26. In a retrospective analysis of malignancy risk with the probability calculator, 62.5% patients were at low-moderate risk whilst 32.5% were at high risk. CONCLUSIONS The clinical practice of managing pulmonary nodules in Asian population differs from ACCP guidelines. None of the patient had pre-test probability calculated, and few had PET scan. This is because upper lobe predominance of lung cancer is identical to TB, non-smoking history does not have any weight in discounting malignancy risk where many of the Asian lung cancer patients are non-smokers, and the local endemicity of TB and its confounding effect on radiological findings of CT scan and PET scan.
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Affiliation(s)
- Chee K Phua
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Wen Y Sim
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kuan Sen Tee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Sennen J W Lew
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Albert Y H Lim
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Dessmon Y H Tai
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Soon Keng Goh
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Ai Ching Kor
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Alan W K Ng
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Akash Verma
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
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17
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Hou G, Miao Y, Hu XJ, Wang W, Wang QY, Wu GP, Wang EH, Kang J. The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study. J Thorac Dis 2016; 8:520-6. [PMID: 27076949 DOI: 10.21037/jtd.2016.02.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated. METHODS A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared. RESULTS Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found. CONCLUSIONS Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.
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Affiliation(s)
- Gang Hou
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Yuan Miao
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Xue-Jun Hu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Wei Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Qiu-Yue Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Guang-Ping Wu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - En-Hua Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Jian Kang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
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