Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

Iachina, Maria; Jakobsen, Erik; Fallesen, Anne Kudsk; Green, Anders

doi:10.1186/s12913-017-2230-3

Cited by 11 publications

(13 citation statements)

References 36 publications

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“…Our findings expose further gaps in the availability and nature of timeframe guidelines. A number of regions lack guidelines, requiring attention given geographical variation in lung cancer epidemiology and survival [38,69]. In addition, guidelines lose utility if they are too broad or arbitrary.…”

Section: Discussionmentioning

confidence: 99%

How long is too long? A scoping review of health system delays in lung cancer

et al. 2018

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Earlier access to lung cancer specialist (LCS) care improves survival, highlighting the need for streamlined patient referral. International guidelines recommend 14-day maximum time intervals from general practitioner (GP) referral to first LCS appointment ("GP-LCS interval"), and diagnosis to treatment ("treatment interval"). We compared time intervals in lung cancer care against timeframe benchmarks, and explored barriers and facilitators to timely care.We conducted a scoping review of literature from MEDLINE, Embase, Scopus and hand searches. Primary end-points were GP-LCS and treatment intervals. Performance against guidelines and factors responsible for delays were explored. We used descriptive statistics and nonparametric Wilcoxon rank sum tests to compare intervals in studies reporting fast-track interventions.Of 1343 identified studies, 128 full-text articles were eligible. Only 33 (26%) studies reported GP-LCS intervals, with an overall median of 7 days and distributions largely meeting guidelines. Overall, 52 (41%) studies reported treatment intervals, with a median of 27 days, and distributions of times falling short of guidelines. There was no effect of fast-track interventions on reducing time intervals. Lack of symptoms and multiple procedures or specialist visits were suggested causes for delay.Although most patients with lung cancer see a specialist within a reasonable timeframe, treatment commencement is often delayed. There is regional variation in establishing timeliness of care.

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Section: Discussionmentioning

confidence: 99%

How long is too long? A scoping review of health system delays in lung cancer

et al. 2018

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“…Among patients with stage IIIB NSQ histology, there was a significant improvement in 1- May 2021 SCAN-LEAF-NSCLC in the Preimmunotherapy Era year OS (95% CI) over time (Fig. 2A; Sweden: 41% [35][36][37][38][39][40][41][42][43][44][45][46][47][48] to 56% [48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65]; p < 0.001; Fig. 3A; Denmark: 43% [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] to 51% [43][44][45]...…”

Section: Os By Disease Stagementioning

confidence: 96%

“…An increase in 3-year OS (95% CI) was observed for patients from Denmark only (Fig. 3B; 33% [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] to 42% [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]; p ¼ 0.03).…”

Section: Os By Disease Stagementioning

confidence: 99%

Epidemiology and Survival Outcomes for Patients With NSCLC in Scandinavia in the Preimmunotherapy Era: A SCAN-LEAF Retrospective Analysis From the I-O Optimise Initiative

Ekman

Horvat

Rosenlund

et al. 2021

JTO Clinical and Research Reports

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Introduction SCAN-LEAF, part of the I-O Optimise initiative, is a retrospective, longitudinal study investigating the epidemiology, clinical care, and outcomes for patients with NSCLC in Scandinavia. We report overall survival (OS) trends for patients diagnosed with NSCLC in Sweden and Denmark between 2005 and 2015. Methods Swedish and Danish cohorts were established by linking national registries. Data on all adults diagnosed with incident NSCLC from January 1, 2005, to December 31, 2015, were included. For temporal analyses of OS trends, patients were stratified by TNM stage and histology. Results Between 2005 and 2015, a total of 30,067 and 31,939 patients from Sweden and Denmark, respectively, were diagnosed with NSCLC; the most common histological subtype was nonsquamous cell carcinoma (56.9% and 53.0%) and 48.4% and 51.6% were diagnosed at stage IV. Over the study period, significant improvements in short-term survival (1 y) were observed for patients with nonsquamous cell carcinoma in both countries, regardless of disease stage at diagnosis; however, improvements in longer-term survival (5 y) were limited to patients with stage I and II disease only. Conversely, among patients with squamous cell histology, improvements in short-term survival were only observed for stage I disease in Sweden and stage IIIA disease in Denmark, while significant improvements in longer-term survival were seen only for stage IIIA NSCLC in both countries. Conclusions Despite some survival improvements between 2005 and 2015, an unmet need remains for patients with advanced NSCLC, particularly those with squamous cell histology. Future analyses will evaluate the impact of newer treatments on OS in NSCLC.

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“…. The referral status of the patient was established by examining whether a patient was referred from hospital of clinical diagnosis to hospital of first-line treatment, as we expect that this will influence the TTT [28]. The first-line treatments were determined by, for each patient, cross-referencing the treatment indications and the time of treatment initiation.…”

Section: Variablesmentioning

confidence: 99%

Variation in the time to treatment for stage III and IV non-small cell lung cancer patients for hospitals in the Netherlands

et al. 2019

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Increased emphasis on molecular diagnostics can lead to increased variation in time to treatment (TTT) for patients with stage III and IV non-small cell lung cancer. This article presents the variation in TTT for advanced NSCLC patients observed in Dutch hospitals before the widespread use of immunotherapy. The aim of this article was to explore the variation in TTT between patients, as well as between hospitals. Material and methods: Based on the Netherlands Cancer Registry, we used patient-level data (n = 4096) from all 78 hospitals that diagnosed stage III or IV NSCLC in the Netherlands in 2016. To investigate how patient characteristics and hospital-level effects are associated with TTT (from diagnosis until start treatment), we interpreted regression model results for five common patient profiles to analyze the influence of age, gender, tumor stage, performance status, histology, and referral status as well as hospital-level characteristics on the TTT. Results and conclusions: TTT varies substantially between and within hospitals. The median TTT was 28 days with an inter-quartile range of 22 days. The hospital-level median TTT ranges from 17 to 68 days. TTT correlates significantly with tumor stage, performance status, and histology. The hospital-level effect, unrelated to hospital volume and type, affected TTT by several weeks at most. For most patients, TTT is within range as recommended in current guidelines. Variation in TTT seems higher for patients receiving either radiotherapy or targeted therapy, or for patients referred to another hospital and we hypothesize this is related to the complexity of the diagnostic pathway. With further advances in molecular diagnostics and precision oncology we expect variation in TTT to increase and this needs to be considered in designing optimal cancer care delivery.

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Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

Cited by 11 publications

References 36 publications

How long is too long? A scoping review of health system delays in lung cancer

How long is too long? A scoping review of health system delays in lung cancer

Epidemiology and Survival Outcomes for Patients With NSCLC in Scandinavia in the Preimmunotherapy Era: A SCAN-LEAF Retrospective Analysis From the I-O Optimise Initiative

Variation in the time to treatment for stage III and IV non-small cell lung cancer patients for hospitals in the Netherlands

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