Lung Cancer Diagnostic and Treatment Intervals in the United States: A Health Care Disparity?

Abstract

Introduction Lung cancer diagnostic and treatment delays have been described for several patient populations. However, few studies have analyzed these intervals among patients treated in contemporary health care systems in the United States. We therefore studied the timing of lung cancer diagnosis and treatment at a U.S. medical center providing care to a diverse patient population within two different hospital systems. Methods We performed a retrospective analysis of consecutive patients diagnosed with non-small cell lung cancer stages I–III from 2000 to 2005 at public and private hospitals affiliated with the University of Texas Southwestern Medical Center. We recorded patient and disease characteristics; dates of initial radiograph suspicious for lung cancer, diagnosis, and treatment; and overall survival. Associations between these factors were assessed using univariate analysis, multivariate logistic regression, and Kaplan-Meier survival analysis. Results A total of 482 patients met criteria for analysis. In univariate analyses, the image-treatment interval was significantly associated with race, age, income, insurance type, and hospital type (76 days for public versus 45 days for private; P<0.0001). In multivariate analysis, only hospital type remained significantly associated with the image-treatment interval; patients in the private hospital setting were more likely to receive timely treatment (HR 1.85; 95% CI, 1.37–2.50; P<0.001). In univariate analysis, the image-treatment interval was not associated with disease stage (P=0.27) or with survival (P=0.42). Conclusion Intervals between suspicion, diagnosis, and treatment of lung cancer vary widely among patients. Health care system factors, such as hospital type, largely account for these discrepancies. In this study, these intervals do not appear associated with clinical outcomes.

Disparities in Lung Cancer Care and Outcomes among Elderly in a Medically Underserved State Population—A Cancer Registry-Linked Database Study

“…Although this result corroborates findings from previous studies, [35][36][37] it contradicts findings from 2 US studies. 38,39 The observed paradoxical results may be explained by selection bias, as symptomatic patients with advanced stage disease are more likely to receive prompt (timely) care, despite their poor prognosis to begin with. Although further research is needed to explore the association between timely care and survival in these patients, data from this study highlight the opportunities for improvement in cancer care in this population.…”

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

“…Those authors found that patients receiving rt had the shortest wait time; patients who received surgery had the longest wait time. Yorio et al 24 reported a median of 33 days and concluded that the length of the interval was associated with the type of the hospital (private vs. public). Li and coauthors 25 reported a 41-day interval from diagnosis to all modalities of first treatment in a retrospective study from Alberta.…”

“…That methodology might explain the slight survival benefit seen in our patients. The available published evidence for an effect of timeliness of care on survival remains indirect and conflicting 24,35 . A systematic review from Olsson et al 9 found no clear evidence that a timely diagnostic pathway resulted in improved survival.…”

Sarcoma Care in an Urban Health-care System: Which Factors Lead to Variance of Care?

“…We also saw a notable trend in the time between symptom onset and first visit with a specialist. Yorio et al found time from initial imaging to treatment to be nearly doubled in lung cancer patients treated at public hospitals compared to private hospitals [26]. Bedell et al saw similar delays in breast cancer patients in public versus private hospitals [27].…”