Timeliness of Care and Lung Cancer Tumor-Stage Progression: How Long Can We Wait?
| Autor: | Stephen A. Deppen, Amelia W. Maiga, David Baker, Jonathan C. Nesbitt, Eric L. Grogan, Eric S. Lambright, Pierre P. Massion, Robert S. Dittus, Carol Callaway-Lane, Rhonda Pinkerman |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Article Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Interquartile range medicine Humans 030212 general & internal medicine Medical diagnosis Stage (cooking) Lung cancer Referral and Consultation Aged Neoplasm Staging Retrospective Studies business.industry Carcinoma Cancer Retrospective cohort study Middle Aged medicine.disease Surgery Exact test 030220 oncology & carcinogenesis Smoking cessation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 104:1791-1797 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2017.06.051 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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