Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?

Abstract

Background Timely care of lung cancer is presumed critical, yet clear evidence of stage progression with delays in care is lacking. We investigated the reasons for delays in treatment and the impact these delays have on tumor-stage progression. Methods We queried our retrospective database of 265 veterans who underwent cancer resection from 2005 to 2015. We extracted time intervals between nodule identification, diagnosis, and surgical resection; changes in nodule radiographic size over time; final pathologic staging; and reasons for delays in care. Pearson’s correlation and Fisher’s exact test were used to compare cancer growth and stage by time to treatment. Results Median time from referral to surgical evaluation was 11 days (interquartile range, 8 to 17). Median time from identification to therapeutic resection was 98 days (interquartile range, 66 to 139), and from diagnosis to resection, 53 days (interquartile range, 35 to 77). Sixty-eight patients (26%) were diagnosed at resection; the remainder had preoperative tissue diagnoses. No significant correlation existed between tumor growth and time between nodule identification and resection, or between tumor growth and time between diagnosis and resection. Among 197 patients with preoperative diagnoses, 42% (83) had intervals longer than 60 days between diagnosis and resection. Most common reasons for delay were cardiac clearance, staging, and smoking cessation. Larger nodules had fewer days between identification and resection (p = 0.03). Conclusions Evaluation, staging, and smoking cessation drive resection delays. The lack of association between tumor growth and time to treatment suggests other clinical or biological factors, not time alone, underlie growth risk. Until these factors are identified, delays to diagnosis and treatment should be minimized.

Time to treatment and survival in veterans with lung cancer eligible for curative intent therapy

“…Clinical stage was not available in this study to assess the proportions of patients upstaged at the time of surgery. Similarly, Maiga and coworkers [24] analyzed 197 lung cancer patients who had a tissue diagnosis and subsequently underwent surgical resection (median diagnosis to surgery time 53 days) at the VA Tennessee Valley Healthcare System from 2005 to 2015, and in univariable analyses, found no significant correlation between time to resection with tumor progression, defined as tumor growth > 0 mm between radiographic and pathologic tumor size; this definition is unlikely to be sensitive to small/subtle changes in tumor growth. In our subgroup analysis of stage I patients, 52 (43%) underwent surgical resection, 18 of whom (35%) were upstaged at the time of surgery; there was no difference in TTT in those upstaged versus those not upstaged (mean 42 vs. 33 days, respectively, t -test for equality of means p = 0.25).…”

The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic

“…We therefore have provided evidence tables with the new studies identified, with additional methodology comments (e-Appendix 2, 3). [6][7][8][9][10][11][12][13][14][15][16][17][18][57][58][59][60][61] The available evidence is often conflicting regarding the relationship between timeliness of care and outcome. 7,13,17 Paradoxically, multiple studies reported that more timely care was associated with worse outcomes.…”

Influence of timeliness and receipt of first treatment on geographic variation in non‐small cell lung cancer mortality

“…NSCLC grows rapidly, and a delay in initiation of treatment can result in disease progression and death 24‐26 . A single‐center study showed no significant correlation between tumor growth and time to resection 27 . However, in that study, there was no multivariate adjustment for clinical or biological factors that underlies growth risk 27 .…”