Delays for diagnosis and treatment of lung cancers: a systematic review

Abstract

Background and Aims:The impact of diagnosis and treatment delays for non-small cell lung cancer management is poorly understood, even if the literature on the subject is currently increasing in importance. We have few indicators that can serve as reference for quality assurance actions. The objective of this review was to review the literature on the subject. Methods: A literature search, using the words 'human lung cancer delay' and 'human lung cancer waiting time' , was undertaken in Medline database. Results: Several studies analyzed these delays mostly in a monocentric setting. There is an important variability in the definition of these delays, in the collection methods and in the results obtained. However, it seems distinctly clear that long delays are frequently observed in less symptomatic patients and, therefore, are accompanied by better prognosis.

Wait Times for Diagnosis and Treatment of Lung Cancer: A Single-Centre Experience

“…In our study, 57% of patients had locally advanced or metastatic disease at presentation. Long management delays are most frequently found in less-symptomatic patients, and hence potentially carry a better prognosis; in contrast, patients with more advanced disease often have more severe symptoms that require expedited investigation and earlier initiation of treatment 23 . Time to treatment might become a more important factor for patients with more rapidly growing tumours or with longer survival times.…”

Predicting delays in lung cancer diagnosis and staging

“…This result is more than acceptable according to current recommendations. A review including 65 papers published between 2007 and 2016 measuring the timeliness of LC diagnosis and treatment in 21 countries found that the most commonly reported wait‐time intervals were from diagnosis to treatment, first visit with a specialist to a confirmed diagnosis, and symptom onset to the first physician visit . This systematic review reported a median delay of 14 days between the first symptom and the first consultation with a general practitioner, 24 days before consulting a specialist, and a range of 29 to 73 days before treatment.…”

“…Some studies that assessed the delay to an LC diagnosis showed median diagnostic intervals between the first symptomatic presentation and diagnosis of LC of approximately 180 days, and in some cases exceeding 300 days . In a systematic review, the median delays to therapeutic care after symptom appearance varied from 47 to 138 days . Some studies have focused on the differences in ambulatory versus hospitalized management of LC, others on tumor size or comorbidities, with different results .…”

Defining a standard set of patient-centred outcomes for lung cancer

“…Previous studies have demonstrated that treatment delays are prognostic in lung cancer [26, 27]. We therefore recommend collecting the time from diagnosis of lung cancer to initiation of treatment.…”