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Kelly RJ, Anderson GD, Joshi BS, Donald JJ. Utility of FDG PET-CT in CT Stage IA non-small cell lung cancer: The New Zealand Te Whatu Ora Northern region experience. J Med Imaging Radiat Oncol 2024. [PMID: 38941179 DOI: 10.1111/1754-9485.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/22/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Our objective was to investigate the utility of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in assessing CT Stage 1A non-small cell lung cancer (NSCLC) in patients under consideration for curative treatment. Performing FDG PET-CT in these patients may lead to unnecessary delays in treatment if it can be shown to provide no added value. METHODS We retrospectively reviewed 735 lesions in 653 patients from the New Zealand Te Whatu Ora Northern region lung cancer database with suspected or pathologically proven Stage 1A NSCLC on CT scan who also underwent FDG PET-CT imaging. We determined how often FDG PET-CT findings upstaged patients and then compared to pathological staging where available. RESULTS FDG PET-CT provided an overall upstaging rate of 9.7%. Category-specific rates were 0% in Tis, 0.9% in T1mi, 7.4% in T1a, 10% in T1b and 12% in T1c groups. The percentage of lesions upstaged on FDG PET-CT that remained Stage 1A was 100% in T1mi, 100% in T1a, 47.1% in T1b and 40.7% in T1c groups. The P value was statistically significant at 0.004, indicating upstaging beyond Stage 1A was dependent on T category. CONCLUSION Our data suggests that FDG PET-CT is indicated for T1b and T1c lesions but is of limited utility in Tis, T1mi and T1a lesions. Adopting a more targeted approach and omitting FDG PET-CT in patients with Tis, T1mi, and T1a lesions may benefit all patients with lung cancer by improving accessibility and treatment timelines.
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Affiliation(s)
- Richard J Kelly
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Graeme D Anderson
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Budresh S Joshi
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
| | - Jennifer J Donald
- Department of Radiology, Counties Manukau Health, Auckland, New Zealand
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Pirzadeh M, Lagina M, Wood C, Valley T, Ramnath N, Arenberg D, Deng JC. Barriers to Timely Lung Cancer Care in Early Stage Non-Small Cell Lung Cancer and Impact on Patient Outcomes. Clin Lung Cancer 2024; 25:135-143. [PMID: 37981476 PMCID: PMC10922667 DOI: 10.1016/j.cllc.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/04/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Optimal time to treatment for early-stage lung cancer is uncertain. We examined causes of delays in care for Veterans who presented with early-stage non-small cell lung cancer (NSCLC) and whether workup time was associated with increased upstaging or all-cause mortality. METHODS We performed a retrospective analysis of Veterans referred to our facility with radiographic stage I or II NSCLC between January 2013 to December 2017, with follow-up through October 2021. Patient demographics, tumor characteristics, time intervals of care, and reasons for delays were collected. Guideline concordance (GC) was defined as treatment within 14 weeks of abnormal image. Multivariable analyses were performed to determine association between delays in care, survival, and upstaging. RESULTS Data from 203 Veterans were analyzed. Median time between abnormal imaging to treatment was 17.7 weeks (IQR 12.7-26.6). Only 33% of Veterans received GC care. Most common patient-related delays were: intercurrent hospitalization/comorbidity (23%), no-shows (16%) and inability to reach Veteran (17%). Most common system-related delay: lack of scheduling availability (25%). Delays associated with upstaging: transportation issues, request for coordination of appointments, and unforeseen appointment changes. Rates of upstaging did not differ between GC and discordant groups (P = .6). GC care was not an independent predictor of mortality. Post-hoc, treatment within 8 weeks was associated with lower rates of upstaging (P = .05). CONCLUSION Although GC care did not impact survival or upstaging for early-stage NSCLC, shorter timeframes may be beneficial. Modifiable delays in care exist which may be addressed at an institutional level to improve timeliness of care.
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Affiliation(s)
- Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
| | - Madeline Lagina
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Cameron Wood
- Division of Hematology and Oncology, Duke University, Durham, NC
| | - Thomas Valley
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Nithya Ramnath
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | - Douglas Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Jane C Deng
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Fowell A, Khan K. Impact of rapid on-site evaluation in expediting the fast investigative lung cancer pathway. Cytopathology 2024; 35:250-255. [PMID: 38054566 DOI: 10.1111/cyt.13345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE EBUS-TBNA is a method of acquiring tissue samples from intrathoracic lymph nodes and central intrathoracic tumours in patients suspected of having lung cancer. Rapid on-site evaluation (ROSE) denotes assessing tissue samples during EBUS (or bronchoscopy), providing instant feedback on sample adequacy and provisional cytomorphological diagnosis. Sector multidisciplinary team (MDT) discussion can then make informed treatment decisions, with confirmatory immunohistochemistry being finalised before provision of final treatment. Currently, impact of ROSE on length of time patients spend on the lung cancer diagnostic pathway remains unclear. METHODS We retrospectively evaluated the impact of ROSE on the length of time between patients' EBUS/bronchoscopy procedures and discussion at sector MDT, referred to as time to treatment decision (TTD), at our institution. Additionally, we assessed impact of ROSE on number of passes (number of times nodes/masses were sampled) per procedure. RESULTS The mean TTD was 77.9% shorter (p = 0.001) with ROSE present than when absent. Patients who received ROSE spend 34.3% less time (p = 0.028) on lung cancer diagnostic pathway overall. There was a significant reduction in number of passes in non-malignant nodes with ROSE present (2.23) than when absent (3.14) (p < 0.001). With ROSE present there was a significantly greater number of passes at malignant sites (5.07) than non-malignant sites (2.23) (p < 0.001). CONCLUSIONS These findings support conclusions made in our institution's previous study, that utilisation of ROSE reduces TTD. ROSE also allows safe advancement through nodes with low suspicion of malignant involvement, focusing time on sampling nodes/masses of greater suspicion.
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Affiliation(s)
- Andrew Fowell
- Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Kashif Khan
- Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
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Apple J, DerSarkissian M, Shah A, Chang R, Chen Y, He X, Chun J. Economic burden of early-stage non-small-cell lung cancer: an assessment of healthcare resource utilization and medical costs. J Comp Eff Res 2023; 12:e230107. [PMID: 37655686 PMCID: PMC10690396 DOI: 10.57264/cer-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Aim: To quantify the economic burden of early-stage non-small-cell lung cancer (NSCLC) among patients with and without adjuvant therapy. Methods: All-cause and NSCLC-related healthcare resource utilization and medical costs were assessed among patients with resected stage IB-IIIA NSCLC in the SEER-Medicare database (1 January 2011-31 December 2019), from NSCLC diagnosis to death, end of continuous enrollment, or end of data availability (whichever occurred first). Results: Patients receiving adjuvant therapy had the lowest mean NSCLC-related medical costs (adjuvant [n = 1776]: $3738; neoadjuvant [n = 56]: $5793; both [n = 47]: $4818; surgery alone [n = 3478]: $4892, per-person-per-month), driven by lower NSCLC-related hospitalization rates. Conclusion: Post-surgical management of early-stage NSCLC was associated with high economic burden. Adjuvant therapy was associated with numerically lower medical costs over surgical resection alone.
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Affiliation(s)
- Jon Apple
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Maral DerSarkissian
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Anne Shah
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Rose Chang
- Analysis Group, 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
| | - Yan Chen
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Xuanhao He
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Justin Chun
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
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Mitzman B. Fighting the Clock: Minimizing Time to Treatment. Ann Thorac Surg 2023; 116:1034-1035. [PMID: 36513164 DOI: 10.1016/j.athoracsur.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Brian Mitzman
- Division of Cardiothoracic Surgery, University of Utah, 30 N 1900 E, #3C127 SOM, Salt Lake City, UT 84132.
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers-Siebers OCJ. Impact of time-to-treatment on survival for early-stage non-small cell lung cancer in The Netherlands-a nationwide observational cohort study. Transl Lung Cancer Res 2023; 12:2015-2029. [PMID: 38025812 PMCID: PMC10654436 DOI: 10.21037/tlcr-23-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Background Varied outcomes on the relation between time-to-treatment and survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. We examined this relation in a large multicentric retrospective cohort study and identified factors associated with extended time-to-treatment. Methods We included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. Time-to-treatment was defined as the number of days between first outpatient visit for suspected lung cancer and start of treatment. The effect of extended time-to-treatment beyond the first quartile and survival was studied with Cox proportional hazard regression. Analyses were stratified for stage and type of therapy. Time-to-treatment was adjusted for multiple covariates including performance status and socioeconomic status. Factors associated with treatment delay were identified by multilevel logistic regression. Results Median time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for both stages. Risk of death increased significantly with extended time-to-treatment for surgical treatment of clinical stage II patients [adjusted hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but not in stage II patients treated with radiotherapy or in stage I patients. Causes of prolonged time-to-treatment were multifactorial including diagnostic tests, such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). Conclusions Clinical stage II patients benefit from fast initiation of surgical treatment. Surprisingly this appears to be accounted for by patients who are clinically stage II but pathologically stage I. Further study is needed on characterizing these patients and the significance of lymph node- or distant micrometastasis in guiding time-to-treatment and treatment strategy.
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Affiliation(s)
- Sosse E. Klarenbeek
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J. Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Michel M. van den Heuvel
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C. J. Schuurbiers-Siebers
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Earnest A, Tesema GA, Stirling RG. Machine Learning Techniques to Predict Timeliness of Care among Lung Cancer Patients. Healthcare (Basel) 2023; 11:2756. [PMID: 37893830 PMCID: PMC10606192 DOI: 10.3390/healthcare11202756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Delays in the assessment, management, and treatment of lung cancer patients may adversely impact prognosis and survival. This study is the first to use machine learning techniques to predict the quality and timeliness of care among lung cancer patients, utilising data from the Victorian Lung Cancer Registry (VLCR) between 2011 and 2022, in Victoria, Australia. Predictor variables included demographic, clinical, hospital, and geographical socio-economic indices. Machine learning methods such as random forests, k-nearest neighbour, neural networks, and support vector machines were implemented and evaluated using 20% out-of-sample cross validations via the area under the curve (AUC). Optimal model parameters were selected based on 10-fold cross validation. There were 11,602 patients included in the analysis. Evaluated quality indicators included, primarily, overall proportion achieving "time from referral date to diagnosis date ≤ 28 days" and proportion achieving "time from diagnosis date to first treatment date (any intent) ≤ 14 days". Results showed that the support vector machine learning methods performed well, followed by nearest neighbour, based on out-of-sample AUCs of 0.89 (in-sample = 0.99) and 0.85 (in-sample = 0.99) for the first indicator, respectively. These models can be implemented in the registry databases to help healthcare workers identify patients who may not meet these indicators prospectively and enable timely interventions.
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Affiliation(s)
- Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | | | - Robert G. Stirling
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC 3004, Australia;
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3168, Australia
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Banks KC, Dusendang JR, Schmittdiel JA, Hsu DS, Ashiku SK, Patel AR, Sakoda LC, Velotta JB. Association of Surgical Timing with Outcomes in Early Stage Lung Cancer. World J Surg 2023; 47:1323-1332. [PMID: 36695837 PMCID: PMC10070299 DOI: 10.1007/s00268-023-06913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Optimal time to surgery for lung cancer is not well established. We aimed to assess whether time to surgery correlates with outcomes. METHODS We assessed patients 18-84 years old who were diagnosed with stage I/II lung cancer at our integrated healthcare system from 2009 to 2019. Time to surgery was defined to start with disease confirmation (imaging or biopsy) prior to the surgery scheduling date. Outcomes of unplanned return to care within 30 days of lung cancer surgery, all-cause mortality, and disease recurrence were compared based on time to surgery before and after 2, 4, and 12 weeks. RESULTS Of 2861 included patients, 70% were over 65 years old and 61% were female. Time to surgery occurred in 1-2 weeks for 6%, 3-4 weeks for 31%, 5-12 weeks for 58%, and 13-26 weeks for 5% of patients. Patients with time to surgery > 4 (vs. ≤ 4) weeks had greater risk of both death (hazard ratio (HR) 1.18, 95% confidence interval (CI) 1.00-1.39) and recurrence (HR 1.33, 95% CI 1.10-1.62). Associations were not statistically significant when dichotomizing time to surgery at 2 or 12 weeks for death (2 week HR 1.23, 95% CI 0.93-1.64; 12 week HR 1.35, 95% CI 0.97-1.88) and recurrence (2 week HR 1.54, 95% CI 0.85-2.80; 12 week HR 2.28, 95% CI 0.80-6.46). CONCLUSIONS Early stage lung cancer patients with time to surgery within 4 weeks experienced lower rates of recurrence. Optimal time to surgical resection may be shorter than previously reported.
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Affiliation(s)
- Kian C Banks
- Department of Surgery, UCSF East Bay, 1411 E 31St St, Oakland, CA, 94602, USA.
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA.
| | - Jennifer R Dusendang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Diana S Hsu
- Department of Surgery, UCSF East Bay, 1411 E 31St St, Oakland, CA, 94602, USA
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Simon K Ashiku
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Ashish R Patel
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Jeffrey B Velotta
- Department of Thoracic Surgery, Kaiser Permanente Northern California, 3600 Broadway, Oakland, CA, 94611, USA
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Kirk F, Crathern K, Chang S, Yong MS, He C, Hughes I, Yadav S, Lo W, Cole C, Windsor M, Naidoo R, Stroebel A. The influence of the COVID-19 pandemic on lung cancer surgery in Queensland. ANZ J Surg 2023. [PMID: 37079774 DOI: 10.1111/ans.18465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland. METHODS We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions. RESULTS There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period. CONCLUSION Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93-2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.
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Affiliation(s)
- Frazer Kirk
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, James Cook University Hospital, Townsville, Queensland, Australia
| | - Kelsie Crathern
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Shantel Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Matthew S Yong
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Cheng He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Wing Lo
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Christopher Cole
- Department of Cardiothoracic Surgery, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Morgan Windsor
- The Department of Thoracic Surgery, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Rishendran Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrie Stroebel
- Department Cardiothoracic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Ko JJ, Banerji S, Blais N, Brade A, Clelland C, Schellenberg D, Snow S, Wheatley-Price P, Yuan R, Melosky B. Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial. Curr Oncol 2023; 30:3817-3828. [PMID: 37185402 PMCID: PMC10137068 DOI: 10.3390/curroncol30040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
The PACIFIC trial showed a survival benefit with durvalumab through five years in stage III unresectable non-small cell lung cancer (NSCLC). However, optimal use of imaging to detect disease progression remains unclearly defined for this population. An expert working group convened to consider available evidence and clinical experience and develop recommendations for follow-up imaging after concurrent chemotherapy and radiation therapy (CRT). Voting on agreement was conducted anonymously via online survey. Follow-up imaging was recommended for all suitable patients after CRT completion regardless of whether durvalumab is received. Imaging should occur every 3 months in Year 1, at least every 6 months in Year 2, and at least every 12 months in Years 3–5. Contrast computed tomography was preferred; routine brain imaging was not recommended for asymptomatic patients. The medical oncologist should follow-up during Year 1 of durvalumab therapy, with radiation oncologist involvement if pneumonitis is suspected; medical and radiation oncologists can subsequently alternate follow-up. Some patients can transition to the family physician/community primary care team at the end of Year 2. In Years 1–5, patients should receive information regarding smoking cessation, comorbidity management, vaccinations, and general follow-up care. These recommendations provide guidance on follow-up imaging for patients with stage III unresectable NSCLC whether or not they receive durvalumab consolidation therapy.
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Siddiqi N, Pan G, Liu A, Lin Y, Jenkins K, Zhao J, Mak K, Tapan U, Suzuki K. Timeliness of Lung Cancer Care From the Point of Suspicious Image at an Urban Safety Net Hospital. Clin Lung Cancer 2023; 24:e87-e93. [PMID: 36642641 DOI: 10.1016/j.cllc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Timeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. Timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. PATIENTS AND METHODS We performed a retrospective analysis of lung cancer patients receiving some portion of their care at Boston Medical Center between 2015 and 2020. A total of 687 patients were included in the final analysis. Median times from suspicious image to first treatment (SIT), suspicious image to diagnosis (SID), and diagnosis to treatment (DT) were calculated. Nonparametric tests were applied to assess for intergroup differences in time intervals. RESULTS SIT, SID, and DT for the entire cohort was 78, 34, and 32 days, respectively. SIT intervals were 87 days for females and 72 days for males (p < .01). SIT intervals were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p < .01). SID intervals differed between black (40.5) and Hispanic (45) patients compared to white (28) and Asian (23) patients (p < .05). CONCLUSION Advanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while white and Asian were associated with more timely lung cancer diagnosis. Future analyses should seek to elucidate drivers of timeliness differences and assess for the impact of timeliness disparities on patient outcomes in the safety net setting.
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Affiliation(s)
- Noreen Siddiqi
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Gilbert Pan
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Anqi Liu
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Yue Lin
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kendall Jenkins
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Jenny Zhao
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kimberley Mak
- Department of Radiation Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Umit Tapan
- Department of Hematology/Oncology, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Kei Suzuki
- Department of Surgery, Inova Fairfax Hospital, Fairfax, VA
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12
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Ballén DF, Carvajal-Fierro CA, Beltrán R, Alarcón ML, Vallejo-Yepes C, Brugés-Maya R. Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country. Cancer Control 2023; 30:10732748231189785. [PMID: 37537995 PMCID: PMC10403982 DOI: 10.1177/10732748231189785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. METHODS A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan-Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. RESULTS 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9-14.4), 13 months for adenocarcinoma (95% CI, 8.1-17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6-4.4) (P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9-10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076-3.082, P=.026) and (HR:14.6, 95% CI, 8.921-24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). CONCLUSIONS Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized.
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Affiliation(s)
- Diego-Felipe Ballén
- Clinical Oncologist, Instituto Nacional de Cancerología, Bogotá, Colombia. Clinical Professor, Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Andrés Carvajal-Fierro
- Thoracic Surgeon, Instituto Nacional de Cancerología, Bogotá, Colombia. Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia
| | - Rafael Beltrán
- Thoracic Surgeon, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Ricardo Brugés-Maya
- Clinical Oncologist, Instituto Nacional de Cancerología, Bogotá, Colombia. Clinical Professor, Department of Internal Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Min Y, Liu Z, Huang R, Li R, Jin J, Wei Z, He L, Pei Y, Li N, Su Y, Hu X, Peng X. Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study. J Transl Med 2022; 20:560. [PMID: 36463201 PMCID: PMC9719121 DOI: 10.1186/s12967-022-03719-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) severely hindered the timely receipt of health care for patients with cancer, especially female patients. Depression and anxiety were more pronounced in female patients than their male counterparts with cancer during treatment wait-time intervals. Herein, investigating the impact of treatment delays on the survival outcomes of female patients with early-stage cancers can enhance the rational and precise clinical decisions of physicians. METHODS We analyzed five types of cancers in women from the Surveillance, Epidemiology, and End Results (SEER) program between Jan 2010 and Dec 2015. Univariate and multivariate Cox regression analyses were used to determine the impacts of treatment delays on the overall survival (OS) and cancer-specific survival (CSS) of the patients. RESULTS A total of 241,661 females with early-stage cancer were analyzed (12,617 cases of non-small cell lung cancer (NSCLC), 166,051 cases of infiltrating breast cancer, 31,096 cases of differentiated thyroid cancer, 23,550 cases of colorectal cancer, and 8347 cases of cervical cancer). Worse OS rates were observed in patients with treatment delays ≥ 3 months in stage I NSCLC (adjustedHazard ratio (HR) = 1.11, 95% Confidence Interval (CI): 1.01-1.23, p = 0.044) and stage I infiltrating breast cancer (adjustedHR = 1.23, 95% CI 1.11-1.37, p < 0.001). When the treatment delay intervals were analyzed as continuous variables, similar results were observed in patients with stage I NSCLC (adjustedHR = 1.04, 95% CI 1.01-1.06, p = 0.010) and in those with stage I breast cancer (adjustedHR = 1.03, 95% CI 1.00-1.06, p = 0.029). However, treatment delays did not reduce the OS of patients with differentiated thyroid cancer, cervical cancer, or colorectal cancer in the early-stage. Only intermediate treatment delays impaired the CSS of patients with cervical cancer in stage I (adjustedHR = 1.31, 95% CI 1.02-1.68, p = 0.032). CONCLUSION After adjusting for confounders, the prolonged time from diagnosis to the initiation of treatment (< 6 months) showed limited negative effects on the survival of most of the patients with early-stage female cancers. Whether our findings serve as evidence supporting the treatment deferral decisions of clinicians for patients with different cancers in resource-limited situations needs further validation.
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Affiliation(s)
- Yu Min
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zheran Liu
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Rendong Huang
- grid.506977.a0000 0004 1757 7957School of Nursing, Hangzhou Medical College, Hangzhou, Zhejiang China
| | - Ruidan Li
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Jing Jin
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zhigong Wei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ling He
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Yiyan Pei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ning Li
- grid.410745.30000 0004 1765 1045Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu China
| | - Yongllin Su
- grid.13291.380000 0001 0807 1581Department of Rehabilitation, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xiaolin Hu
- grid.13291.380000 0001 0807 1581West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xingchen Peng
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
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Lynch C, Harrison S, Butler J, Baldwin DR, Dawkins P, van der Horst J, Jakobsen E, McAleese J, McWilliams A, Redmond K, Swaminath A, Finley CJ. An International Consensus on Actions to Improve Lung Cancer Survival: A Modified Delphi Method Among Clinical Experts in the International Cancer Benchmarking Partnership. Cancer Control 2022; 29:10732748221119354. [PMID: 36269109 PMCID: PMC9596933 DOI: 10.1177/10732748221119354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Research from the International Cancer Benchmarking Partnership (ICBP) demonstrates that international variation in lung cancer survival persists, particularly within early stage disease. There is a lack of international consensus on the critical contributing components to variation in lung cancer outcomes and the steps needed to optimise lung cancer services. These are needed to improve the quality of options for and equitable access to treatment, and ultimately improve survival. METHODS Semi-structured interviews were conducted with 9 key informants from ICBP countries. An international clinical network representing 6 ICBP countries (Australia, Canada, Denmark, England, Ireland, New Zealand, Northern Ireland, Scotland & Wales) was established to share local clinical insights and examples of best practice. Using a modified Delphi consensus model, network members suggested and rated recommendations to optimise the management of lung cancer. Calls to Action were developed via Delphi voting as the most crucial recommendations, with Good Practice Points included to support their implementation. RESULTS Five Calls to Action and thirteen Good Practice Points applicable to high income, comparable countries were developed and achieved 100% consensus. Calls to Action include (1) Implement cost-effective, clinically efficacious, and equitable lung cancer screening initiatives; (2) Ensure diagnosis of lung cancer within 30 days of referral; (3) Develop Thoracic Centres of Excellence; (4) Undertake an international audit of lung cancer care; and (5) Recognise improvements in lung cancer care and outcomes as a priority in cancer policy. CONCLUSION The recommendations presented are the voice of an expert international lung cancer clinical network, and signpost key considerations for policymakers in countries within the ICBP but also in other comparable high-income countries. These define a roadmap to help align and focus efforts in improving outcomes and management of lung cancer patients globally.
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Affiliation(s)
- Charlotte Lynch
- International Cancer Benchmarking Partnership (ICBP) and Strategic Evidence, Policy, Information & Communications, Cancer Research UK, London, UK,Charlotte Lynch, International Cancer Benchmarking Partnership, Cancer Research UK 2 Redman Place, London, E20 1JQ, UK.
| | - Samantha Harrison
- International Cancer Benchmarking Partnership (ICBP) and Strategic Evidence, Policy, Information & Communications, Cancer Research UK, London, UK
| | - John Butler
- International Cancer Benchmarking Partnership (ICBP) and Strategic Evidence, Policy, Information & Communications, Cancer Research UK, London, UK,Gynaecology Department, Royal Marsden NHS Foundation Trust, London, UK
| | - David R. Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Paul Dawkins
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | | | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Jonathan McAleese
- Department of Clinical Oncology, Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland, UK
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital and University of Western Australia, Perth, Australia
| | - Karen Redmond
- Department of Thoracic Surgery and Transplantation, Mater Misericordiae University Hospital and School of Medicine, Dublin, Ireland
| | - Anand Swaminath
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Christian J. Finley
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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Evison M, Shackley D, Galligan-Dawson L. Regional single-queue scheduling platform for specialist diagnostics in the lung cancer pathway: accelerating cancer recovery from the COVID-19 pandemic. BMJ Open Respir Res 2022; 9:9/1/e001321. [PMID: 35902134 PMCID: PMC9340577 DOI: 10.1136/bmjresp-2022-001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022] Open
Abstract
Lung cancer is the single biggest cause of cancer death. The diagnostic pathway can be complex, including specialist cancer diagnostics that are not performed at every hospital. One such example is endobronchial ultrasound (EBUS), a day-case bronchoscopic procedure used for nodal staging and tissue diagnosis. In this proof-of-concept pilot in Greater Manchester, we tested a novel digital EBUS booking platform. This platform was accessible across multiple acute care trusts and provided visibility of all available EBUS appointments, allowing referring teams to book directly into the appropriate slot. During a 6-month pilot, 193 EBUS procedures were booked through this new single-queue platform. The median waiting times reduced by 2 days from 9 to 7 days (22% reduction and saving approximately 386 days in total) and reduced variation in waiting times by 1 day from 5 to 4 days (20% reduction). 98% of patients who completed an experience of care survey felt the process was 'very well' or 'well' organised and 77% felt the most important factor in deciding where to have their EBUS was the earliest possible appointment regardless of travel. This proof-of-concept pilot has shown improvements in cancer waiting times with significant future potential in delivering specialist cancer diagnostics.
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Affiliation(s)
- Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Manchester University NHS Foundation Trust, Manchester, UK .,Greater Manchester Cancer Alliance, Manchester, UK
| | - David Shackley
- Greater Manchester Cancer Alliance, Greater Manchester Strategic Health Authority, Manchester, UK
| | - Lisa Galligan-Dawson
- Greater Manchester Cancer Alliance, Greater Manchester Strategic Health Authority, Manchester, UK
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16
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Influencing factors of lung cancer patients' participation in shared decision-making: a cross-sectional study. J Cancer Res Clin Oncol 2022; 148:3303-3312. [PMID: 35716189 DOI: 10.1007/s00432-022-04105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate and analyze the level of actual participation and perceived importance of shared decision-making on treatment and care of lung cancer patients, to compare their differences and to explore their influencing factors. METHODS A total of 290 lung cancer patients were collected from oncology and thoracic surgery departments of a comprehensive medical center in Qingdao from October 2018 to December 2019. Participants completed a cross-sectional questionnaire to assess their actual participation and perceived importance in shared decision-making on treatment and care. Descriptive analysis and non-parametric tests were carried out to assess the status quo of patients' shared decision-making on treatment and care. Binary logistic regression analysis with a stepwise back-wards was applied to predict factors that affected patients' participation in shared decision-making. RESULTS The results showed that patients with lung cancer had a low degree of participation in shared decision-making. There were significant differences between actual participation and perceived importance of shared decision-making on treatment and care. Education level, age, gender, income, marital status, personality, the course of the disease (> 6 months), and the pathological TNM staging (III) affected patient's level of participation in shared decision-making. CONCLUSION Actual participation in shared decision-making on the treatment and care of lung cancer patients was low and considered unimportant. We could train oncology nurses to use patient decision aids to help patients and families participate in shared decision-making on patients' value, preferences and needs.
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers OCJ. Impact of time-to-treatment on survival for advanced non-small cell lung cancer patients in the Netherlands: a nationwide observational cohort study. Thorax 2022; 78:467-475. [PMID: 35450944 DOI: 10.1136/thoraxjnl-2021-218059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The assumption that more rapid treatment improves survival of advanced non-small cell lung cancer (NSCLC) has not yet been proven. We studied the relation between time-to-treatment and survival in advanced stage NSCLC patients in a large multicentric nationwide retrospective cohort. Additionally, we identified factors associated with delay. METHOD We selected 10 306 patients, diagnosed and treated between 2014 and 2019 for clinical stage III and IV NSCLC, from the Netherlands Cancer Registry that includes nationwide data from 109 Dutch hospitals. Associations between survival and time-to-treatment were tested with Cox proportional hazard regression analyses. Time-to-treatment was adjusted for multiple covariates including diagnostic procedures and type of therapy. Factors associated with delay were identified by multilevel logistic regression. RESULTS Risk of death significantly decreased with longer time-to-treatment for stage III patients receiving only radiotherapy (adjusted HR, aHR >21 days: 0.59 (95% CI 0.48 to 0.73)) or any type of systemic therapy (aHR >49 days: 0.72 (95% CI 0.56 to 0.91)) and stage IV patients receiving chemotherapy and/or immunotherapy (aHR >21 days: 0.81 (95% CI 0.73 to 0.88)). No significant association was found for stage III patients treated with chemoradiotherapy and stage IV patients treated with targeted therapy. More complex diagnostic procedures often delay treatment. CONCLUSION Although in general it is important to start treatment as early as possible, our study finds no evidence that a more rapid start of treatment improves outcomes in advanced stage NSCLC patients. The benefit of urgent treatment is probably confounded by unmeasured patient and tumour characteristics and, clinical urgency dictating timelines of treatment. Time-to-treatment and its impact should be continuously evaluated as therapeutic strategies continue to evolve and improve.
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Affiliation(s)
- Sosse E Klarenbeek
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J Aarts
- Research and Development, Dutch Association of Comprehensive Cancer Centres, Utrecht, The Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C J Schuurbiers
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
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