Timeliness of care and prognosis in patients with lung cancer

Barcala, Francisco Javier González; Falagan, J.A.; Prim, Jose Maria Garcia; Valdés, Luis; Carreira, José M.; Puga, Ana Ramírez; Martín-Lancharro, Pablo; García-Sanz, Maria Teresa; Antón-Sanmartin, Diana; Cánive-Gómez, Juan-Carlos; Pose‐Reino, Antonio; López‐López, Rafael

doi:10.1007/s11845-013-1025-8

Cited by 21 publications

(27 citation statements)

References 34 publications

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“…We know that disease severity of disease at the time of diagnosis affects the speed of medical decision making, with more advanced cancers having shorter delays to treatment, and smaller, early stage lung cancer associated with greater delays [12]. Our finding that larger tumors had shorter delays in care echoes multiple prior papers that have shown that larger tumors or more advanced cancers receive more timely care [11, 12, 18, 20, 22, 32]. …”

Section: Commentsupporting

confidence: 64%

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

Maiga

Deppen

Pinkerman

et al. 2017

The Annals of Thoracic Surgery

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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.

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Section: Commentsupporting

confidence: 64%

“…Our diagnosis and treatment delays are longer than others reported in the literature, particularly from those in populations outside the United States [10, 18–20]. Another single VA facility reported a median of 48 days from presentation to diagnosis and 22 days from diagnosis to treatment [21].…”

Section: Commentmentioning

confidence: 75%

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

Maiga

Deppen

Pinkerman

et al. 2017

The Annals of Thoracic Surgery

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“…For that reason, it is not surprising that the association between survival and wait time in advanced-stage disease is reversed. Gonzalez-Barcala et al 38 reported that patients with advanced-stage disease have a shorter treatment delay and that a longer treatment delay was associated with longer survival. However, we cannot exclude the possibility that cancer biology might play a role in that association.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…All remaining text was reviewed and direct and indirect evidence was selected and presented in evidence tables for final review and core panel discussion. With the exception of one single-center retrospective observational study related to PICO question 2, 5 and 13 studies related to PICO question 5, [6][7][8][9][10][11][12][13][14][15][16][17][18] no other direct evidence was identified. Evidence was graded by the methodology team using the standard GRADE quality assessment tool categorized as high, moderate, low, or very low.…”

Section: Study Selection and Evidence Assessmentmentioning

confidence: 99%

“…56 A supplemental literature review identified 13 additional references. [6][7][8][9][10][11][12][13][14][15][16][17][18] The methodology of the studies, the definitions used, and the evidence quality precluded arriving at a point estimate of the effect of time delay on outcomes. Issues included varying definitions of when cancer was first identified (eg, symptoms vs imaging vs tissue diagnosis), which interval was relevant (eg, symptoms to treatment vs diagnosis to treatment), heterogeneity in populations (eg, surgically treated vs all patients with lung cancer), differences in histology (eg, all types vs non-small cell lung cancer), intractable problems because of residual confounding within groups, confounding by indication (eg, sicker patients seen more rapidly), selection bias, and failure to adjust for lead time bias (eg, measuring survival from time of treatment rather than time of presentation).…”

Section: Remarksmentioning

confidence: 99%

The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic

Wahidi

Shojaee

Lamb

et al. 2020

Chest

170

149

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BACKGROUND: The coronavirus disease 2019 (COVID-19) has swept the globe and is causing significant morbidity and mortality. Given that the virus is transmitted via droplets, open airway procedures such as bronchoscopy pose a significant risk to health-care workers (HCWs). The goal of this guideline was to examine the current evidence on the role of bronchoscopy during the COVID-19 pandemic and the optimal protection of patients and HCWs. STUDY DESIGN AND METHODS: A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that addressed specific topics on bronchoscopy related to COVID-19 infection and transmission. MEDLINE (via PubMed) was systematically searched for relevant literature and references were screened for inclusion. Validated evaluation tools were used to assess the quality of studies and to grade the level of evidence to support each recommendation. When evidence did not exist, suggestions were developed based on consensus using the modified Delphi process. RESULTS: The systematic review and critical analysis of the literature based on six PICO questions resulted in six statements: one evidence-based graded recommendation and 5 ungraded consensus-based statements. INTERPRETATION: The evidence on the role of bronchoscopy during the COVID-19 pandemic is sparse. To maximize protection of patients and HCWs, bronchoscopy should be used sparingly in the evaluation and management of patients with suspected or confirmed COVID-19 infections. In an area where community transmission of COVID-19 infection is present, bronchoscopy should be deferred for nonurgent indications, and if necessary to perform, HCWs should wear personal protective equipment while performing the procedure even on asymptomatic patients.

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Timeliness of care and prognosis in patients with lung cancer

Abstract: The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

Cited by 21 publications

References 34 publications

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

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

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

The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic

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