Lung Cancer Care Trajectory at a Canadian Centre: An Evaluation of How Wait Times Affect Clinical Outcomes

Kasymjanova, G.; Small, David; Cohen, Victor; Jagoe, R. Thomas; Batist, Gerald; Sateren, Warren B.; Ernst, Pierre; Pepe, C.; Sakr, Lama; Agulnik, J.

doi:10.3747/co.24.3611

Cited by 37 publications

(45 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 2016 study showed that time-to-treatment (TTT) from first medical oncology visit was 34 days, improved to 22 days even after reflex testing of EGFR mutational analysis was implemented [ 13 ]. A study from Canada showed that median TTT from the diagnosis of lung cancer to the initiation of treatment was 32 days and that the patients whose treatment was not initiated within 30 days had significantly worse survival compared to the patients whose treatment was initiated within 30 days [ 14 ]. Estimating the incidence of EGFR mutation using existing clinical characteristics could be valuable in facilitating decision making as to whether systemic chemotherapy or TKI should be started while awaiting the result of EGFR mutation analysis, hence shortening the TTT, and improving patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma

et al. 2017

View full text Add to dashboard Cite

Activating epidermal growth factor receptor (EGFR) mutations in metastatic non-small cell lung cancer (NSCLC) are associated with a high response rate to EGFR tyrosine kinase inhibitor (TKI). The current guidelines recommend routine EGFR mutational analysis prior to initiating first line systemic therapy. The clinical characteristics including smoking status, histologic type, sex and ethnicity are known to be associated with the incidence of EGFR mutations. We retrospectively analyzed 277 patients with metastatic NSCLC within Kaiser Permanente Northern California (KPNC); among these patients, 83 were positive for EGFR mutations. We performed both univariate and multivariable logistic regressions to identify predictors of EGFR mutations. We found that histologic grade was significantly associated with the incidence of EGFR mutation, regardless of ethnicity, sex and smoking status. In grade I (well differentiated) and II (moderately differentiated), histology was associated with significantly higher incidence of EGFR mutations compared to grade II–III (moderate-to-poorly differentiated) and III (poorly differentiated). Ever-smokers with grade III lung adenocarcinoma had 1.8% incidence of EGFR mutations. This study indicates that histologic grade is a predictive factor for the incidence of EGFR mutations and suggests that for patients with grade II–III or III lung adenocarcinoma, prompt initiation of first-line chemotherapy or immunotherapy is appropriate while awaiting results of EGFR mutational analysis, particularly for patients with history of smoking.

show abstract

Section: Introductionmentioning

confidence: 99%

Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Looking at these studies some reached comparable results, like Coughlin et al, who showed that UICC stage II NSCLC patients have a significantly decreased survival when the patient work-up from the decision to operate to resection took two months or more 9 . Kasymjanova et al reached similar results, describing a beneficial effect on survival for early and locoregional stage disease, when the biopsy-to-treatment interval was 30 days or less 10 . In contrast to these results some publications state that there is no relationship between survival and prolonged delay to treatment or even that shorter delay causes reduced survival 11 , 12 .…”

Section: Discussionmentioning

confidence: 68%

Delay to surgical treatment in lung cancer patients and its impact on survival in a video-assisted thoracoscopic lobectomy cohort

Ponholzer

Kroepfl

et al. 2021

Sci Rep

View full text Add to dashboard Cite

Patient pathways from first suspicious imaging until final surgical treatment vary and in some instances cause considerable delay. This study aims to investigate the impact of this delay on survival of lung cancer patients. The institutional database was queried to identify patients with primary lung cancer who were treated with primary surgery. Time intervals were defined as date of first suspicious medical images until date of surgical treatment. All patients received PET-CT staging and tissue confirmation prior to treatment planning in a multidisciplinary tumor board. Patients with unknown date of first contact, follow-up CT-scans of pulmonary nodules, or neoadjuvant therapy were excluded. In total, 287 patients treated between 2009 and 2017 were included for further analysis. Median time between first suspicious medical imaging and surgical therapy was 62 (range 23–120) days and did not differ between male and female patients. Patients were then classified into two groups according to the duration of the medical work-up: group A up to 60 days, and group B from 61 to 120 days. Clinical T and N stages were comparable between the groups. There was no difference in overall survival between the two groups. In the subgroup of cT2 tumors (87 patients), there was a significant survival benefit for patients in group A (p = 0.043), while nodal stages, stage migration, lymphatic vessel invasion, grading and other potentially survival-influencing clinical parameters were comparable between the groups. Delay between diagnosis and treatment of lung cancer may result in dismal outcome. Efforts need to focus on improving and streamlining patient pathways to shorten the delay until surgical treatment to a minimum. Process improvement might be achieved by stringent interdisciplinary work-up and a patient-centered approach.

show abstract

“…Most cases (90%) were non-small cell lung cancer, 36% of the patients had no comorbid conditions, 28% were never smokers, and 60% were advanced stage. Characteristics of the study sample were similar to registry patient characteristics except for smoking status where the study sample had almost double the number of never smokers [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…We collected the following data from the registry: age at diagnosis, sex, referral source, referral date, diagnosis date, and stage of disease. Stages I and II were categorized as early, stage III as locoregional, and stage IV as advanced [ 14 ]. Additionally, postal codes were used to convert to an area-based deprivation score for each patient [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

et al. 2021

View full text Add to dashboard Cite

Background: Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral. Methods: In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (n = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities. Results: 68% of the patients followed a pathway where family physician (FP) visits were dominant (“FP-centric”) and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant (“ED-centric”). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12–111) vs. 22 (IQR: 5–69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit. Conclusions: Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.

show abstract

Lung Cancer Care Trajectory at a Canadian Centre: An Evaluation of How Wait Times Affect Clinical Outcomes

Abstract: Background Lung cancer continues to be one of the most common cancers in Canada, with approximately 28,400

Cited by 37 publications

References 33 publications

Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma

Histologic Grade Is Predictive of Incidence of Epidermal Growth Factor Receptor Mutations in Metastatic Lung Adenocarcinoma

Delay to surgical treatment in lung cancer patients and its impact on survival in a video-assisted thoracoscopic lobectomy cohort

Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral

Contact Info

Product

Resources

About