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

Gray, S.; Bu, Jingyu; Saint-Jacques, Nathalie; Rayson, Daniel; Younis, Tallal

doi:10.3747/co.19.1020

Cited by 4 publications

(1 citation statement)

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“…Data from the Netherlands has shown a similar decrease in surgery and increase in the use of radiation in the presence of comorbidity, especially COPD [ 12 ]. While previous data has shown seemingly low rates of adjuvant chemotherapy among individuals with resected lung cancer in Canada [ 22 , 23 ], our study showed that individuals with COPD were somewhat less likely to receive adjuvant chemotherapy. Gao et al reported worse disease-free survival in their meta-analysis, although it was not possible to discern whether this was due to less aggressive curative therapy or differences in stage [ 8 ].…”

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confidence: 86%

Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

et al. 2021

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Hypothesis There is limited data on the care and outcomes of individuals with both chronic obstructive pulmonary disease (COPD) and lung cancer, particularly in advanced disease. We hypothesized such patients would receive less cancer treatment and have worse outcomes. Methods We analyzed administrative data from the province of Ontario including demographics, hospitalization records, physician billings, cancer diagnosis, and treatments. COPD was defined using the ICES-derived COPD cohort (1996–2014) with data from 2002 to 2014. Descriptive statistics and multivariable analyses were undertaken. Results Of 105 304 individuals with lung cancer, 43 375 (41%) had stage data and 36 738 (34.9%) had COPD. Those with COPD were likely to be younger, have a Charlson score ≤ 1, have lower income, to live rurally, and to have stage I/II lung cancer (29.8 vs 26.5%; all p<0.001). For the COPD population with stage I/II cancer, surgery and adjuvant chemotherapy were less likely (56.8 vs. 65.9% and 15.4 vs. 17.1%, respectively), while radiation was more likely (26.0 vs. 21.8%) (p all < 0.001). In the stage III/IV population, individuals with COPD received less chemotherapy (55.9 vs 64.4%) or radiation (42.5 vs 47.5%; all p<0.001). Inhaler and oxygen use was higher those with COPD, as were hospitalizations for respiratory infections and COPD exacerbations. On multivariable analysis, overall survival was worse among those with COPD (HR 1.20, 95% CI 1.19–1.22). Conclusions A co-diagnosis of COPD and lung cancer is associated with less curative treatment in early stage disease, less palliative treatment in late stage disease, and poorer outcomes.

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Section: Discussioncontrasting

confidence: 86%

Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

et al. 2021

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Timing in initiating lung cancer treatment after bronchoscopy in France: Study from medico-administrative database

et al. 2016

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Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

Iachina

Jakobsen

Fallesen

et al. 2017

BMC Health Serv Res

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BackgroundLung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested as a potential cause of the poor prognosis and as consequence, fast track cancer care pathways were implemented describing maximum acceptable time thresholds from referral to treatment. In Denmark, patients with lung cancer are often transferred between hospitals with diagnostic facilities to hospitals with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis and treatment of Non-Small Cell Lung Cancer (NSCLC).MethodsWe performed a historical prospective cohort study using data from the Danish Lung Cancer Registry (DLCR). All patients diagnosed with primary NSCLC from January 1st 2008 to December 31st 2012 were included. Patients with unresolved pathology and incomplete data on the dates of referral, diagnosis and treatment were excluded.ResultsA total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68–0.96)) and in total time from referral to treatment (HR 0.84 (0.77–0.92)), than no-transfer patients. Transfer patients had lower odds of being diagnosed (Odds Ratio (OR) 0.82 (0.74–0.94) and treated (OR 0.66 (0.61–0.72) within the acceptable time thresholds described in the care pathway.ConclusionFast track cancer care pathways were implemented to unify and accelerate the diagnosis and treatment of cancer. We found that the transfer between hospitals during the care pathway might cause delay from diagnosis to treatment as well as in the total time from referral to treatment in patients with Non Small-Cell Lung Cancer. The difference between no-transfer and transfer patients persists after adjusting for known predictors of delay.

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

Abstract: at high resolution may optimize insights into emerging trends within cancer care systems.

Cited by 4 publications

References 24 publications

Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

Management and outcomes of patients with chronic obstructive lung disease and lung cancer in a public healthcare system

Timing in initiating lung cancer treatment after bronchoscopy in France: Study from medico-administrative database

Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

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