Timeliness of Care in Veterans With Non-small Cell Lung Cancer

Gould, Michael K.; Ghaus, Sharfun; Olsson, Julie; Schultz, Ellen

doi:10.1378/chest.07-2654

Cited by 72 publications

(74 citation statements)

References 21 publications

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“…Colleoni et al 19 reported that early initiation of chemotherapy among estrogen receptor-negative breast cancer patients was associated with increased survival, but early initiation did not significantly affect patients with estrogen receptor-positive breast cancer. In a study of 129 veterans with lung cancer, time to treatment initiation did not significantly affect survival, although a trend toward greater survival among individuals with solitary pulmonary nodules who were treated in a more timely manner was observed 20 . Recently, a meta-analysis presented by Raphael et al 21 found that increased delays in the receipt of adjuvant chemotherapy were associated with significant decreases in both overall survival and disease-free survival.…”

Section: Discussionmentioning

confidence: 95%

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

Halpern

Holden

2012

Current Oncology

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Background: Timeliness of care (rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment. The present study evaluated factors influencing timeliness of care for U.S. Medicare enrollees. Methods: Data for Medicare enrollees diagnosed with breast, colorectal, lung, or prostate cancer while living in U.S. seer (Surveillance, Epidemiology and End Results) regions in 2000–2002 were analyzed. Patients were classified as experiencing delayed treatment if the interval between diagnosis and treatment was greater than the 95th percentile for each cancer site. The impacts of patient sociodemographic, clinical, and area-based factors on the likelihood of delayed treatment were analyzed using multivariate logistic regression. Results: Black patients (compared with white patients) and patients initially treated with radiation therapy or chemotherapy (rather than surgery) had a greater likelihood of treatment delays across all four cancer sites. Hispanic status, dual Medicare–Medicaid status, location of initial treatment (inpatient vs. outpatient), and stage at diagnosis also affected timeliness of care for some cancer sites. Surprisingly, area-based factors reflecting availability of cancer care services were not significantly associated with timeliness of care or were associated with greater delays in areas with greater numbers of service providers. Conclusions: Multiple factors affected receipt of timely cancer care for members of the study population, all of whom had coverage of medical care services through Medicare. Because delays in treatment initiation can increase morbidity, decrease quality of life, shorten survival, and result in greater costs, prospective studies and tailored interventions are needed to address those factors among at-risk patient groups.

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Section: Discussionmentioning

confidence: 95%

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

Halpern

Holden

2012

Current Oncology

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Nadpara

Madhavan

Tworek

2016

Population Health Management

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Despite availability of guidelines for lung cancer care, variations in lung cancer care among the elderly exist across the nation and are a cause for concern in rural and medically underserved areas. Therefore, the purpose of this study was to evaluate the patterns of lung cancer care and associated health outcomes among elderly residing in a rural and medically underserved area. The authors identified 1924 elderly lung cancer patients from the West Virginia Cancer Registry-Medicare linked database (2002)(2003)(2004)(2005)(2006)(2007) and categorized them by receipt of guideline-concordant (appropriate and timely) care using guidelines from the American College of Chest Physicians, British Thoracic Society, and the RAND Corporation. Hierarchical generalized logistic models were constructed to identify variables associated with receipt of guideline-concordant care. KaplanMeier analysis and log-rank test were used to compare 3-year survival outcomes. Multivariate Cox proportional hazards models were constructed to estimate lung cancer mortality risk associated with nonreceipt of guidelineconcordant care. Although guideline-concordant appropriate care was received by fewer than half of all patients (46.5%), of those receiving care, 78.7% received it in a timely manner. Delays in diagnosis and treatment varied significantly. Survival outcomes significantly improved with appropriate care (799 vs. 366 days; P £ 0.05), but did not improve with timely care. This study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among the elderly residing in rural and medically underserved areas. Although lung cancer diagnostic and management services are covered under the Medicare program, underutilization of these services is a concern.

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“…The dates and type of tests were easily identified from the institution's clinical information system, so that delays could be accurately measured and compared. Previous authors have reported that advanced disease may be associated with more prompt investigation and treatment [9,10]. It is unlikely that sicker patients would be systematically referred to the RIC.…”

Section: Discussionmentioning

confidence: 99%

“…Salomaa et al examined delays for 132 patients with NSCLC at a Finnish hospital and reported a median delay from specialist visit to diagnosis of 15 days (mean [13]. A United States of America (USA) study of veterans reported median delays of 42 days for diagnosis and 84 days for first treatment [10]. Wait times for diagnosis and treatment in Canada vary across provinces.…”

Section: Discussionmentioning

confidence: 99%

“…More advanced patients may require more urgent evaluation, thereby decreasing overall survival in patients treated sooner. However, in the subgroup of patients with solitary pulmonary nodules, there was a trend toward improved survival with shorter time to treatment [10]. O'Rourke et al reported tumor growth while patients waited for radiotherapy treatment by comparing diagnostic and CT simulation scans, suggesting that delays to treatment may be associated with worse outcomes [28].…”

Section: Discussionmentioning

confidence: 99%

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Impact of rapid investigation clinic on timeliness of lung cancer diagnosis and treatment

et al. 2017

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Background: Guidelines recommend timely evaluation of patients with suspected lung cancer. We evaluated the impact of a Rapid Investigation Clinic (RIC) on timeliness of lung cancer diagnosis and treatment between February 2010 and December 2011. Methods: Investigation within the RIC was conducted by a pulmonologist and a nurse clinician. Controls were patients with lung cancer, investigated outside the RIC at the same institution during the same time period. The primary outcome was time between first contact with a local physician for suspected lung cancer (T0) and first treatment. Factors associated with the delay from T0 to first treatment were examined using multivariate analysis. Completeness of lung cancer staging according to guidelines was assessed. Results: A total of 195 patients were investigated within the RIC vs. 132 patients outside the RIC. The median delay between T0 and first treatment was 65 days (interquartile range [IQR] 46-92 days) in the RIC and 78 days (IQR 49-119 days) in the non-RIC patients (p ≤ 0.01). Time from T0 to pathological diagnosis was shorter in the RIC (median 26 days; IQR 14-42 days) vs. non-RIC patients (median 40 days; IQR 16-68 days). In multivariate analysis, investigation in the RIC was associated with a reduction in time to first treatment of 24 days (95% confidence interval [CI] 12-35 days) when adjusted for relevant confounders. Guideline-concordant investigation occurred more frequently in RIC patients, based on the quality indicators examined. Conclusions: A Rapid Investigation Clinic reduces delays to lung cancer diagnosis and treatment, and impacts quality of care.

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Timeliness of Care in Veterans With Non-small Cell Lung Cancer

Cited by 72 publications

References 21 publications

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

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

Impact of rapid investigation clinic on timeliness of lung cancer diagnosis and treatment

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