Factors affecting delay in diagnosis and treatment of lung cancer

Abstract

Aim: Lung cancer (LC) is one of the most prominant causes of mortality in the world. Delays in diagnosis and treatment gravely affect the prognosis of the disease. Our aim is to investigate the factors that affect delay in diagnosis and treatment in patients with LC. Methods: In this retrospective cohort study, LC patients who were diagnosed in the pulmonary diseases clinic between January 2010 and August 2011 were retrospectively evaluated from patient files. The sociodemographic characteristics of the patients (age, gender, occupation and educational level), symptom type, presence of other malignancies, radiological location of the lesion, diagnostic method, histological type, presence of endobronchial lesion, stage of LC, length of times between admission, diagnosis and treatment were noted. Results: One hundred seven (87.7%) patients were male and 15 patients (12.3%) were female. Eighty-nine patients (73%) were under the age of 70 years. Ninety-eight patients were diagnosed with non-small cell (NSCLC) and 24 patients, with small cell lung cancer (SCLC). The mean duration from symptom onset to admission to the hospital (SA), from symptom onset to pathological diagnosis (SP), from symptom onset to initiating treatment (ST), from admission to the hospital until pathological diagnosis (AP), from admission to the hospital until initiating treatment (AT) were 30, 60, 75,5, 14, 33 days, respectively. There were statistically significant differences between SP, AP, AT periods (P=0.017, P=0.011 and P=0.006 respectively) with regards to education levels, and between SA, SP, ST, and from symptom onset to performing an initial radiological examination (SR) periods in terms of social security institution (P<0.05 for all). AT time of patients with SCLC was shorter than that of patients with NSCLC. Conclusion: Early diagnosis of LC is particularly important. Therefore, determination of factors affecting the delay in diagnosis and treatment of LC, probable causes, and solutions should be investigated.

Keywords

• Lung cancer
• delays
• diagnosis
• treatment

Akciğer kanserinde tanı ve tedavi gecikme faktörleri

Abstract

Amaç: Akciğer kanseri dünya çapında en önemli mortalite nedenlerinden biridir. Tanı ve tedavi gecikmesi hastalığın prognozunu etkileyen en önemli faktörlerdendir. Amacımız; akciğer kanseri tanısı almış hastalarda tanı ve tedavi gecikmesini etkileyen faktörleri araştırmaktır. Yöntemler: Ocak 2010 – Ağustos 2011 tarihleri arasında göğüs hastalıkları kliniğinde tanı konulan akciğer kanserli hastaların dosyaları retrospektif olarak incelendi. Hastaların sosyodemografik özellikleri (yaş, cinsiyet, meslek ve eğitim düzeyi), semptom tipi, başka malignite varlığı, lezyonun radyolojik lokalizasyonu, tanı yöntemi, histolojik tip, endobronşiyal lezyon varlığı, akciğer kanseri evresi, başvuru, tanı ve tedavi arasındaki sürelerin uzunluğu kaydedildi. Çalışma, retrospektif kohort çalışmasıdır. Bulgular: Olguların 107’ si (%87,7) erkek ve 15’ i (%12,3) kadındı. 89 olgu (%73) 70 yaş altındaydı. 98 olgu küçük hücre dışı akciğer kanseri (KHDAK) iken 24 olgu küçük hücreli akciğer kanseri (KHAK) idi. Semptomlarının başlangıcından hastaneye başvurusuna (SB), semptomların başlangıcından patolojik tanıya (SP), tedavi başlangıcına (ST), başvurudan patolojik tanıya (BP), başvurudan tedavi başlangıcına (BT) kadar geçen ortalama süre sırayla 30, 60, 75,5, 14, 33 gün olarak bulundu. Öğrenim düzeyi ile SP, BP, BT süreleri (sırasıyla P=0,017, P=0,011 ve P=0,006); sosyal güvence ile SB, SP, ST, SR süreleri arasında istatistiksel olarak anlamlı farklılık saptandı (P<0,05 tümü için). KHAK’ de BT süresi KHDAK’ ye göre daha kısa olduğu saptandı Sonuç: Akciğer kanserinde erken tanı konulması oldukça önemlidir. Bu nedenle tanı ve tedaviyi geciktirecek faktörlerin saptanması, olası nedenlerinin ve çözümlerinin araştırılması gerekmektedir.

Keywords

• Akciğer kanseri
• Gecikmeler
• Tanı
• Tedavi

References

1. 1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebello M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar;136(5):E359–86. doi: 10.1002/ijc.29210.
2. 2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. Mar-Apr 2011;61(2):69-90. doi: 10.3322/caac.20107.
3. 3. National Cancer Institute, Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Cancer of the Lung and Bronchus. [Cited 21 Feb 2018.] http://seer.cancer.gov/statfacts/html/lungb.html.
4. 4. Fernandez de la Vega JF, Perez H, Samper JA. Lung cancer diagnostic delay in a Havana hospital. MEDICC Review. January 2015;17(1):55-8.
5. 5. Koo MM, Zhou Y, Lyratzopoulos G. Delays in diagnosis and treatment of lung cancer: Lessons from US healthcare settings. Cancer Epidemiol. 2015 Dec;39(6):1145–7. doi: 10.1016/j.canep.2015.08.008.
6. 6. Vinas F, Hassen BI, Jabot L, Monnet I, Chouaid C. Delays for diagnosis and treatment of lung cancers: a systematic review. Clin Respir J. 2016 May;10(3):267–71. doi: 10.1111/crj.12217.
7. 7. Byrne SC, Barrett B, Bhatia R. The impact of diagnostic imaging wait times on the prognosis of lung cancer. Can Assoc Radiol J. 2015 Feb;66(1):53–7. doi: 10.1016/j.carj.2014.01.003.
8. 8. Wang L, Correa CR, Hayman JA, Zhao L, Cease K, Brenner D, et al. Time to treatment in patients with stage III non–small cell lung cancer. Int J Radiat Oncol Biol Phys. 2009 Jul 1;74(3):790–5. doi: 10.1016/j.ijrobp.2008.08.039.

9. 9. Coughlin S, Plourde M, Guidolin K, Fortin D, Frechette E, Malthaner R, et al. Is it safe to wait? The effect of surgical wait time on survival in patients with nonsmall cell lung cancer. Can J Surg. 2015 Dec;58(6):414–8. doi: 10.1503/cjs.007015.
10. 10. Goldberg SW, Mulshine JL, Hagstrom D, Pyenson BS. An actuarial approach to comparing early stage and late stage lung cancer mortality and survival. Popul Health Manag. 2010 Feb;13(1):33–46. doi: 10.1089/pop.2009.0010.
11. 11. Hill LLE, Collier G, Gemine RE. A patient perspective: Identifying and understanding the barriers associated with the diagnostic delay of lung cancer. EMJ Respir. 2017;5(1):92–98.
12. 12. Chatwin J, Povey A, Kennedy A, Frank T, Firth A, Booton R, et al. The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer. BMC Public Health. 2014 Oct 7;14:1043. doi: 10.1186/1471-2458-14-1043.
13. 13. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC lung cancer staging project: Proposals for the revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016 Jan;11(1):39-51. doi: 10.1016/j.jtho.2015.09.009.
14. 14. Salomaa ER, Sallinen S, Hiekkanen H, Liippo K. Delays in the diagnosis and treatment of lung cancer. Chest. 2005 Oct;128(4):2282-8. doi: 10.1378/chest.128.4.2282.
15. 15. G Myrdal, M Lambe, G Hillerdal, K Lamberg, Th Agustsson and E Stahle. Effect of delays on prognosis in patients with non-small cell lung cancer. Thorax. 2004 Jan;59(1):45-9.
16. 16. Ost DE, Yeung SCJ, Tanoue LT, Gould MK. Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e121S–e141S. doi: 10.1378/chest.12-2352.
17. 17. Fernandez VL, Roibas CM, Rodriguez EG, Rial MB, Hernandez CR, Duran MT, et al. Predicting delays in lung cancer diagnosis and staging. Thorac Cancer. 2019 Feb;10(2):296-303. doi: 10.1111/1759-7714.12950.
18. 18. Özdemir T, Başay N, Mutluay N, Bayız H, Berktaş B, Berkoğlu M. Akciğer Kanserinde Tanı ve Tedavi Gecikmesi. Solunum Hastalıkları. 2007;18(4):100-7.
19. 19. Evans SM, Earnest A, Bower W, Senthuren M, McLaughlin P, Stirling R. Timeliness of lung cancer care in Victoria: a retrospective cohort study. Med J Aust. 2016 Feb 1;204(2):75. doi: 10.5694/mja15.01026.
20. 20. Chandra S, Mohan A, Guleria R, Singh V, Yadav P. Delays during the diagnostic evaluation and treatment of lung cancer. Asian Pac J Cancer Prev. Jul-Sep 2009;10(3):453-6.
21. 21. Akpınar EE, Gülhan M. Akciğer Kanserinde Tanı ve Tedavi Gecikmesini Etkileyen Faktörler. Türkiye Solunum Araştırmaları Derneği 32. Ulusal Kongresi, 20-24 Kasım 2010; Antalya, EP-35.
22. 22. Acharya S, Pun R, Sharma S. P1.01-048 Factors Contributing Delays during Management of Lung Cancer: A Study from Tertiary Level Hospital in Nepal. Journal of Thoracic Oncology. January 2017;12(1):S479-S480. doi.org/10.1016/j.jtho.2016.
23. 23. Yaman N, Ozgen A, Celik P, Ozyurt BC, Nese N, Coskun AS, et al. Factors affecting the interval from diagnosis to treatment in patients with lung cancer. Tumori. Nov-Dec 2009;95(6):702-5.
24. 24. Quazzani HE, Menchafou I, Achachi L, Ftouh ME, Fihry MTEF. Delay in the diagnosis of primary bronchial cancer. Study carried out in the pneumology unit of Ibn Sina university hospital, Rabat (Morocco). Rev Pneumol Clin. 2010 Dec;66(6):335-41. doi: 10.1016/j.pneumo.2010.02.004.
25. 25. Barcala FJG, Prim JMG, Dobano JMA, Rodriguez MM , Sanz MTG, Reino AP, et al. Effect of delays on survival in patients with lung cancer. Clin Transl Oncol. 2010 Dec;12(12):836–42. doi: 10.1007/s12094-010-0606-5.
26. 26. Maiga AW, Deppen SA, Pinkerman R, Lane CC, Massion PP, Dittus RS et al. Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait? Ann Thorac Surg. 2017 Dec;104(6):1791–7.doi: 10.1016/j.athoracsur.2017.06.051.
27. 27. Kim JOA, Davis F, Butts C, Winget M. Waiting Time Intervals for Non-small Cell Lung Cancer Diagnosis and Treatment in Alberta: Quantification of Intervals and Identification of Risk Factors Associated with Delays. Clin Oncol (R Coll Radiol). 2016 Dec;28(12):750-9. doi: 10.1016/j.clon.2016.06.010.
28. 28. Gomez DR, Liao KP, Swisher SG, Blumenschein GR, Erasmus Jr JJ, Buchholz TA, et al. Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival. Radiother Oncol. 2015 May;115(2):257-63. doi: 10.1016/j.radonc.2015.04.010.
29. 29. Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, et al. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer. 2015 Mar 31;112(Suppl 1):S6-13. doi: 10.1038/bjc.2015.30.
30. 30. Wagland R, Brindle L, Ewings S, James E, Moore M, Rivas C, et al. Promoting help-seeking in response to symptoms amongst primary care patients at high risk of lung cancer: A mixed method study. PLoS One. 2016 Nov 4;11(11):e0165677. doi: 10.1371/journal.pone.0165677.