Treatment delay in lung cancerTime to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival
Section snippets
Materials and methods
This study was granted exempt status by The University of Texas MD Anderson Cancer Center’s institutional review board. Patients were selected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry (TCR)-Medicare databases, which collectively report data on incident malignancies diagnosed in patients residing in 17 geographic catchments representing approximately 34% of the US population. The patient population consisted of 28,732 patients and is further
Results
Of 28,732 patients, 27.7% had local, 31.2% regional, and 41.1% distant disease. Other patient characteristics are listed in Table 1. The incidence of PET according to SEER stage was 38.9% for those with localized disease (n = 3069/7960), 46.4% for regional (n = 4158/8962), and 36.9% for distant (n = 4356/11,810). The median time from diagnosis to treatment was 27 days, and 36.7% of patients (n = 10,554) experienced delay between diagnosis and treatment. Both staging studies and other study covariates
Discussion
In this population-based analysis of the effect of disease-staging studies on delays in beginning treatment for newly diagnosed NSCLC, our pertinent findings are as follows. First, almost 40% of patients had substantial treatment delays after the diagnosis of lung cancer. Second, delays in treatment were correlated with changes in survival, with this association being stage dependent. Finally, the cause of delays was multifactorial and related to several staging studies obtained after diagnosis
Conflict of interest statement
The authors have no conflicts of interest to declare.
Funding sources and acknowledgments
Supported in part by Cancer Center Support (Core) Grant CA016672 to The University of Texas MD Anderson Cancer Center and the Center for Radiation Oncology Research. Drs. Gomez, Smith, and Giordano are supported by the Cancer Prevention and Research Institute of Texas’s Comparative Effectiveness Research in Texas (RP101207). Dr. Giordano is also supported by American Cancer Society 117488-RSGI-09-149-01-CPHPS. The authors sincerely thank Christine Wogan, M.S., E.L.S., of MD Anderson’s Division
References (22)
- et al.
Rapid disease progression with delay in treatment of non-small-cell lung cancer
Int J Radiat Oncol Biol Phys
(2011) - et al.
The impact of time between staging PET/CT and definitive chemo-radiation on target volumes and survival in patients with non-small cell lung cancer
Radiother Oncol
(2013) - et al.
Early CT and FDG-metabolic tumour volume changes show a significant correlation with survival in stage I-III small cell lung cancer: a hypothesis generating study
Radiother Oncol
(2011) - et al.
Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: a first step toward implementing a multidisciplinary, evidence-based guideline
Lung Cancer
(2006) - et al.
Quality indicators in cancer care: development and implementation for improved health outcomes in non-small-cell lung cancer
Clin Lung Cancer
(2009) - et al.
Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence
Int J Radiat Oncol Biol Phys
(2000) - et al.
Time in radiation oncology - keep it short!
Radiother Oncol
(2013) - et al.
Oesophageal tumour progression between the diagnostic (1)(8)F-FDG-PET and the (1)(8)F-FDG-PET for radiotherapy treatment planning
Radiother Oncol
(2013) - et al.
Treatment delays in non-small cell lung cancer and their prognostic implications
J Thorac Oncol
(2011) - et al.
High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose-positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer
Cancer
(2010)