Analysis of Wait Times and Costs During the Peri-Diagnostic Period for Non-Small Cell Lung Cancer

Cheung, Winson Y.; Butler, James R.G.; Kliewer, Erich V.; Demers, Alain; Musto, Grace; Welch, Stephen; Sivananthan, Gokulan; Navaratnam, S.

doi:10.1016/j.lungcan.2010.08.001

Cited by 19 publications

(17 citation statements)

References 28 publications

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“…Despite guidelines that assist primary care physicians in referring advanced lung cancer patients, therapeutic nihilism among primary care physicians might be persistent 21,[26][27][28] . A delay in diagnosis might also have contributed, because data suggest that, within the current Canadian infrastructure, wait time from abnormal imaging to diagnosis and treatment of lung cancer remains in excess of 60-90 days across the country [29][30][31][32] . We note that, in our study, most patients were first seen by a radiation oncologist, before a medical oncologist.…”

Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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Introduction Only approximately 25% of stage iv non-small-cell lung cancer (nsclc) patients receive systemic therapy. For such patients, we examined factors affecting referral to a cancer centre (cc) and to medical oncology (mo), and use of systemic therapy. were referred to a cc, with 22% and 23% receiving traditional chemotherapy (tctx). Referral to a cc or mo and use of tctx correlated with survival (p < 0.0001): The mos duration was 11.2 months in those receiving tctx and 1.0 months in those not referred to a cc. The overall mos duration was similar in the two cohorts (4.1 months vs. 3.9 months, p = 0.47). Major reasons for lack of referral to mo included poor functional status, rapid decline, and patient wish, which were similar to the reasons for forgoing tctx. In the two cohorts, 87 (9.4%) and 42 (7.5%) patients received epidermal growth factor inhibitors, with a mos duration of 16.2 months. Multivariable analysis showed that male sex [hazard ratio (hr): 1.16; p = 0.008] and pulmonary embolus (hr: 1.2; p = 0.002) correlated with worse survival. In contrast, receipt of chemotherapy (hr: 0.5; p < 0.001) and enrolment in a clinical trial (hr: 0.76; p = 0.049) correlated with better survival. Methods ConclusionsOur experience confirms that, over time, uptake of systemic therapy, including tctx and targeted therapy, changed little despite their established efficacy. Most of the factors limiting systemic therapy uptake appear to be non-modifiable at the time of referral. Rapid diagnosis and the availability of well-tolerated drugs for all nsclc patients will likely be the most important factors in increasing systemic therapy uptake in this population.

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Section: Discussionmentioning

confidence: 99%

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Tudor

et al. 2017

Current Oncology

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“…20 Following these promising initial results, phase III randomized trials comparing SBRT to lobectomy or limited resection were initiated by large oncological groups. However, two studies were terminated early due to poor accrual 6, 7 and only one phase III study is ongoing but no longer recruiting patients. 21, 22 …”

Section: Discussionmentioning

confidence: 99%

“…However, two phase III studies comparing SBRT to lobectomy and one phase III study comparing SBRT to sub-lobar resection in potentially operable patients have been closed due to slow patient accrual. 6, 7 Similarly, there is limited information regarding SBRT-related toxicities, particularly among less selected older individuals treated in the community. Despite the lack of comparative data, use of SBRT for early stage lung cancer is rapidly increasing.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after Stereotactic Body Radiotherapy versus Limited Resection in Older Patients with Early-Stage Lung Cancer

Ezer

Veluswamy

Mhango

et al. 2015

Journal of Thoracic Oncology

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Background Limited resection and stereotactic body radiotherapy (SBRT) have emerged as treatment options for older early stage non-small cell lung cancer (NSCLC) patients who are not good candidates for lobectomy. Methods We used the Surveillance, Epidemiology and End Results-Medicare registry to identify patients >65 years of age with stage I–II NSCLC and negative lymph nodes treated with SBRT vs. limited resection. We fitted a propensity score model predicting use of SBRT and compared adjusted overall survival of patients treated with SBRT vs. limited resection. Secondary analyses stratified the sample by type of limited resection (wedge vs. segmentectomy), age (≤75 vs. >75 years), and tumor size (<3 vs. ≥3 cm). We also compared rates of surgical complications and SBRT-related toxicity in the two groups. Results We identified 2,243 patients of which 362 (16%) received SBRT. SBRT-treated patients were older, had higher comorbidity scores and larger tumors (p<0.001 for all comparisons). Adjusted analyses showed no differences in survival (hazard ratio [HR]:1.19; 95% confidence interval [CI]: 0.97–1.47) among patients treated with SBRT vs. limited resection. While survival of patients who underwent SBRT vs. wedge resection was not different (HR: 1.22; 95% CI: 0.98–1.52), SBRT was associated with worse outcomes when compared to segmentectomy (HR: 1.55; 95% CI: 1.18–2.03). Adverse events were most often respiratory and more frequent in the patients treated with limited resection (28% vs 14%, p<0.001). Conclusion SBRT is better tolerated and associated with similar survival when compared to wedge resection but not to segmentectomy in older patients with node negative NSCLC.

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“…A number of other studies have also reported significant changes over time in chemotherapy Uptake for patients with early-stage nsclc 12,13,19 and also in elapsed times for patients with early-stage breast cancer 20 . More importantly, the more detailed analysis of overall treatment Uptake (that is, the analysis of referral and treatment patterns separately) and the elapsed-times analyses based on high-resolution care intervals (compared with intervals used in other reports) in the present study were more informative in understanding changes in care patterns [21][22][23] . The analysis of overall Uptake identified a number of factors associated with higher chemotherapy use, including younger age, less comorbidity, higher disease stage, cbrh treatment centre, and moreaggressive surgery.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy Uptake and Wait Times in Early-Stage Non-Small-Cell Lung Cancer

Gray

Saint-Jacques

et al. 2012

Current Oncology

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Analysis of Wait Times and Costs During the Peri-Diagnostic Period for Non-Small Cell Lung Cancer

Cited by 19 publications

References 28 publications

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Reasons for Lack of Referral to Medical Oncology for Systemic Therapy in Stage Iv Non-small-cell Lung Cancer: Comparison of 2003–2006 with 2010–2011

Outcomes after Stereotactic Body Radiotherapy versus Limited Resection in Older Patients with Early-Stage Lung Cancer

Chemotherapy Uptake and Wait Times in Early-Stage Non-Small-Cell Lung Cancer

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