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Digby GC, Habert J, Sahota J, Zhu L, Manos D. Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews. J Thorac Dis 2024; 16:1537-1551. [PMID: 38505054 PMCID: PMC10944736 DOI: 10.21037/jtd-23-1453] [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: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 03/21/2024]
Abstract
Background and Objective Incidental pulmonary nodules (IPNs) are common and increasingly detected with the overall rise of radiologic imaging. Effective IPN management is necessary to ensure lung cancer is not missed. This study aims to describe the current landscape of IPN management in Canada, understand barriers to optimal IPN management, and identify opportunities for improvement. Methods We performed a narrative literature review by searching biomedical electronic databases for relevant articles published between January 1, 2010, and November 22, 2023. To validate and complement the identified literature, we conducted structured interviews with multidisciplinary experts involved in the pathway of patients with IPNs across Canada. Interviews between December 2021 and May 2022 were audiovisual recorded, transcribed, and thematically analyzed. Key Content and Findings A total of 1,299 records were identified, of which 37 studies were included for analysis. Most studies were conducted in Canada and the United States and highlighted variability in radiology reporting of IPNs and patient management, and limited adherence to recommended follow-up imaging. Twenty experts were interviewed, including radiologists, respirologists, thoracic surgeons, primary care physicians, medical oncologists, and an epidemiologist. Three themes emerged from the interviews, supported by the literature, including: variability in radiology reporting of IPNs, suboptimal communication, and variability in guideline adherence and patient management. Conclusions Despite general awareness of guidelines, there is inconsistency and lack of standardization in the management of patients with IPNs in Canada. Multidisciplinary expert consensus is recommended to help overcome the communication and operational barriers to a safe and cost-effective approach to this common clinical issue.
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Affiliation(s)
- Geneviève C. Digby
- Department of Medicine, Division of Respirology, Queen’s University, Kingston, ON, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jyoti Sahota
- Health Economics and Market Access, Amaris Consulting, Toronto, ON, Canada
| | - Lucía Zhu
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Erefai O, Soulaymani A, Mokhtari A, Obtel M, Hami H. Diagnostic delay in lung cancer in Morocco: A 4-year retrospective study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Xie F, Zheng K, Liu L, Jin X, Fu L, Zhu Z. A Pilot Study of Radiomics Models Combining Multi-Probe and Multi-Modality Images of 68Ga-NOTA-PRGD2 and 18F-FDG PET/CT for Differentiating Benign and Malignant Pulmonary Space-Occupying Lesions. Front Oncol 2022; 12:877501. [PMID: 35720018 PMCID: PMC9201288 DOI: 10.3389/fonc.2022.877501] [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: 02/16/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background This is a pilot study of radiomics based on 68Ga-NOTA-PRGD2 [NOTA-PEG4-E[c(RGDfK)]2)] and 18F-FDG PET/CT to (i) evaluate the diagnostic efficacy of radiomics features of 68Ga-NOTA-PRGD2 PET in the differential diagnosis of benign and malignant pulmonary space-occupying lesions and (ii) compare the diagnostic efficacy of multi-modality and multi-probe images. Methods We utilized a dataset of 48 patients who participated in 68Ga-NOTA-PRGD2 PET/CT and 18F-FDG PET/CT clinical trials to extract image features and evaluate their diagnostic efficacy in the differentiation of benign and malignant lesions by the Mann-Whitney U test. After feature selection with sequential forward selection, random forest models were developed with tenfold cross-validation. The diagnostic performance of models based on different image features was visualized by receiver operating characteristic (ROC) curves and compared by permutation tests. Results Fourteen of the 68Ga-NOTA-PRGD2 PET features between benign and malignant pulmonary space-occupying lesions had significant differences (P<0.05, Mann-Whitney U test). Eighteen of the 68Ga-NOTA-PRGD2 PET features demonstrated higher AUC values than all CT features in the differential diagnosis of pulmonary lesions. The AUC value (0.908) of the three-modal feature model was significantly higher (P<0.05, permutation test) than those of the single- and dual-modal models. Conclusion 68Ga-NOTA-PRGD2 PET features have better diagnostic capacity than CT features for pulmonary space-occupying lesions. The combination of multi-modality and multi-probe images can improve the diagnostic efficiency of models. Our preliminary clinical hypothesis of using radiomics based on 68Ga-NOTA-PRGD2 PET images and multimodal images as a diagnostic tool warrants further validation in a larger multicenter sample size.
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Affiliation(s)
- Fei Xie
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Department of Nuclear Medicine, Peking Union Medical College Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and Peking Union Medical College (PUMC), Beijing, China.,Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kun Zheng
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Department of Nuclear Medicine, Peking Union Medical College Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and Peking Union Medical College (PUMC), Beijing, China
| | - Linwen Liu
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Department of Nuclear Medicine, Peking Union Medical College Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and Peking Union Medical College (PUMC), Beijing, China
| | - Xiaona Jin
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Department of Nuclear Medicine, Peking Union Medical College Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and Peking Union Medical College (PUMC), Beijing, China
| | - Lilan Fu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaohui Zhu
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Department of Nuclear Medicine, Peking Union Medical College Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Science and Peking Union Medical College (PUMC), Beijing, China
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Ansar A, Lewis V, McDonald CF, Liu C, Rahman MA. Defining timeliness in care for patients with lung cancer: a scoping review. BMJ Open 2022; 12:e056895. [PMID: 35393318 PMCID: PMC8990712 DOI: 10.1136/bmjopen-2021-056895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early diagnosis and reducing the time taken to achieve each step of lung cancer care is essential. This scoping review aimed to examine time points and intervals used to measure timeliness and to critically assess how they are defined by existing studies of the care seeking pathway for lung cancer. METHODS This scoping review was guided by the methodological framework for scoping reviews by Arksey and O'Malley. MEDLINE, EMBASE, CINAHL and PsycINFO electronic databases were searched for articles published between 1999 and 2019. After duplicate removal, all publications went through title and abstract screening followed by full text review and inclusion of articles in the review against the selection criteria. A narrative synthesis describes the time points, intervals and measurement guidelines used by the included articles. RESULTS A total of 2113 articles were identified from the initial search. Finally, 68 articles were included for data charting process. Eight time points and 14 intervals were identified as the most common events researched by the articles. Eighteen different lung cancer care guidelines were used to benchmark intervals in the included articles; all were developed in Western countries. The British Thoracic Society guideline was the most frequently used guideline (20%). Western guidelines were used by the studies in Asian countries despite differences in the health system structure. CONCLUSION This review identified substantial variations in definitions of some of the intervals used to describe timeliness of care for lung cancer. The differences in healthcare delivery systems of Asian and Western countries, and between high-income countries and low-income-middle-income countries may suggest different sets of time points and intervals need to be developed.
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Affiliation(s)
- Adnan Ansar
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Virginia Lewis
- School of Nursing and Midwifery, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
| | - Christine Faye McDonald
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Muhammad Aziz Rahman
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
- Australian Institute for Primary Care and Aging, La Trobe University, Bundoora, Victoria, Australia
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Okoli GN, Lam OLT, Reddy VK, Copstein L, Askin N, Prashad A, Stiff J, Khare SR, Leonard R, Zarin W, Tricco AC, Abou-Setta AM. Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review. BMJ Open 2021; 11:e055488. [PMID: 34753768 PMCID: PMC8578990 DOI: 10.1136/bmjopen-2021-055488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals. DESIGN A scoping review following the Joanna Briggs Institute's methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SOURCES MEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021. ELIGIBILITY AND CRITERIA Study participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis. DATA EXTRACTION AND SYNTHESIS We summarised findings graphically and descriptively. RESULTS From 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator. CONCLUSIONS Multidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.
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Affiliation(s)
- George N Okoli
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Otto L T Lam
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Viraj K Reddy
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie Copstein
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anubha Prashad
- Canadian Partnership Against Cancer (the Partnership), Toronto, Ontario, Canada
| | - Jennifer Stiff
- Canadian Partnership Against Cancer (the Partnership), Toronto, Ontario, Canada
| | - Satya Rashi Khare
- Canadian Partnership Against Cancer (the Partnership), Toronto, Ontario, Canada
| | - Robyn Leonard
- Canadian Partnership Against Cancer (the Partnership), Toronto, Ontario, Canada
| | - Wasifa Zarin
- Knowledge Translation Program, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality, Joanna Briggs Institute (JBI) Centre of Excellence at Queen's University, Kingston, Ontario, Canada
| | - Ahmed M Abou-Setta
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Laerum D, Brustugun OT, Gallefoss F, Falk R, Strand TE, Fjellbirkeland L. Factors associated with delayed treatment initiation in an unselected cohort of patients with small-cell lung cancer. Cancer Treat Res Commun 2021; 29:100477. [PMID: 34700140 DOI: 10.1016/j.ctarc.2021.100477] [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: 08/27/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is an aggressive, rapidly progressive malignancy. Thus, expedient diagnosis and treatment initiation is important. This study identifies and quantifies factors associated with delayed diagnosis and treatment initiation in patients with SCLC and compares time to treatment in SCLC with a cohort of patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The study included all patients diagnosed with SCLC at a hospital in southern Norway in a ten-year period (2007-2016), and all NSCLC patients during the period 2013-2016. Total time to treatment (TTT), was defined as the number of days from date of referral due to suspicion of lung cancer to first day of treatment. Factors associated with prolonged TTT were estimated using multivariate median regression analysis. RESULTS The median TTT and interquartile range (IQR) for the 183 patients with SCLC was 16 (10-23) days. Factors associated with delayed TTT included outpatient versus inpatient evaluation (+8.4 days), number of diagnostic procedures (+4.3 days per procedure), stage I-III versus stage IV (+3.6 days) and age (+2.1 days per 10 years). In 2013-16, TTT in SCLC was 3.5 days shorter than in the period before and less than half that of NSCLC in the same period, 15 (9-22) versus 33 (22-50) days (p = 0.001). CONCLUSION Shorter TTT is seen in higher stage, while longer TTT is a result of increasing complexity of the diagnostic process and treatment decisions of patients with curative intent treatment. Knowledge on delaying factors can shorten TTT and improve clinical practice.
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Affiliation(s)
- Dan Laerum
- Department of Internal Medicine, Pulmonary Section, Sorlandet Hospital Kristiansand, postboks 416 Lundsiden, Kristiansand,4604, Norway.
| | - Odd Terje Brustugun
- Section of Oncology, Vestre Viken Hospital Trust, Postboks 800, Drammen, 3004, Norway
| | - Frode Gallefoss
- Department of Research, Sorlandet Hospital Kristiansand, postboks 416 Lundsiden, 4604 Kristiansand, Norway and Medical Faculty, University of Bergen, Bergen, Norway
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Pb 4950 Nydalen, Oslo,0424, Norway
| | | | - Lars Fjellbirkeland
- Department of Respiratory Medicine, Oslo University Hospital, University of Oslo, Postboks 4950 Nydalen Oslo,0424, Norway
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An Audit of CT Chest Reports and Their Potential Impact on the Workup of Patients with Suspected Lung Cancer. Can Respir J 2021; 2021:6647087. [PMID: 34194587 PMCID: PMC8203401 DOI: 10.1155/2021/6647087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Quality gaps exist in the diagnostic evaluation of lung cancer patients. The initial CT chest guides the workup of patients with suspected lung cancer. We sought to determine how frequently CT reports provided guideline-concordant recommendations with regard to additional imaging studies and/or invasive diagnostic procedures. Methods. This was a retrospective study. The records of patients referred for investigation of suspected lung cancer between January 1, 2015, and June 30, 2016, were reviewed. Patients with confirmed lung cancer, for whom CT scan images and reports were available, are included. CT reports were reviewed, with attention to additional imaging studies and/or invasive diagnostic procedures suggested. These recommendations were examined against current guidelines for lung cancer diagnosis and staging, based on suspected disease stage. Results One hundred forty-six patients are included in the analysis. Most patients were diagnosed with non-small-cell lung cancer (NSCLC), and 63% had advanced disease (stages III and IV). Only 12% of CT reports contained guideline-concordant recommendations for additional imaging studies, with PET scan suggested in only 6% of reports. Potential invasive diagnostic procedures were suggested in one fifth of CT reports, and only 58% of these recommendations were in keeping with current guidelines. In particular, transthoracic needle aspiration (TTNA) was suggested in 26% of patients despite advanced stage disease. Conclusion Guideline-concordant recommendations for investigation of suspected lung cancer are rarely available on CT reports. This is true with respect to both imaging studies and invasive diagnostic procedures. Incorporation of more evidence-based suggestions may reduce quality gaps in lung cancer diagnosis and staging.
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Lung Cancer Pre-Diagnostic Pathways from First Presentation to Specialist Referral. ACTA ACUST UNITED AC 2021; 28:378-389. [PMID: 33440696 PMCID: PMC7903286 DOI: 10.3390/curroncol28010040] [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: 12/07/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/01/2022]
Abstract
Background: Lung cancer is often diagnosed at a late stage with high associated mortality. Timely diagnosis depends on timely referral to a respiratory specialist; however, in Canada, little is known about how patients move through primary care to get to a respiratory specialist. Accordingly, we aimed to identify and describe lung cancer pre-diagnostic pathways in primary care from first presentation to referral. Methods: In this retrospective cohort study, patients with primary lung cancer were recruited using consecutive sampling (n = 50) from a lung cancer center in Montréal, Québec. Data on healthcare service utilization in primary care were collected from chart reviews and structured patient interviews and analyzed using latent class analysis to identify groups of patients with similar pre-diagnostic pathways. Each group was described based on patient- and tumor-related characteristics and the sequence of utilization activities. Results: 68% of the patients followed a pathway where family physician (FP) visits were dominant (“FP-centric”) and 32% followed a pathway where walk-in clinic and emergency department (ED) visits were dominant (“ED-centric”). Time to referral in the FP group was double that of the ED group (45 days (IQR: 12–111) vs. 22 (IQR: 5–69)) with more advanced disease (65% vs. 50%). In the FP group, 29% of the patients saw their FP three times or more before being referred and 41% had an ED visit. Conclusions: Our findings may reflect the challenge of diagnosing lung cancer in primary care, missed opportunities for earlier diagnosis, and a lack of integration between primary and specialist care.
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Veenstra JS, Khalid T, Stewart KC, Valji A, Bédard ELR, Johnson S, Laing B, Turner SR. Automatic Referral for Potential Thoracic Malignant Diseases Detected on Computed Tomographic Scan. Ann Thorac Surg 2020; 110:1869-1873. [PMID: 32599050 DOI: 10.1016/j.athoracsur.2020.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Delays in care negatively affect patients with potentially resectable thoracic malignant diseases. The Alberta Thoracic Oncology Program established an automatic referral process for patients with chest computed tomographic (CT) scans suggestive of malignant disease. The objective of this study was to determine whether automatic referral was associated with decreased time to referral or differences in the quality of referral information received. METHODS A single-center retrospective review of patients referred to a Canadian tertiary thoracic surgical center was performed. The time between the CT scan and the date of referral was calculated, and the type of information provided with the referral was tabulated. Automatic and traditional referral groups were compared using the Student t test, the Mann-Whitney U test, and multivariable analysis. RESULTS A total of 689 patients met inclusion criteria, and 405 of these patients were automatic referrals. Average time to referral was shorter in the automatic referral group (4.7 days vs 23.6 days; P < .001). Only 2 automatic referrals took longer than 30 days, compared with more than 25% of traditional referrals. Automatic referrals were always associated with a shorter time for referral on subgroup analysis of lung nodules, different referring physician types, and patient location. There was no difference between referral types in the number of referral data provided to the center. CONCLUSIONS Automatic referrals for patients with potential thoracic malignant disease have a significant beneficial impact on delays in care, and this could result in improved outcomes, such as decreased upstaging and improved survival. This was not associated with a decrease in the amount of information provided with the referral. Thus, automatic referrals may streamline patient care without compromising quality.
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Affiliation(s)
- James S Veenstra
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Tehreem Khalid
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kenneth C Stewart
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Azim Valji
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Johnson
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Bryce Laing
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Laerum D, Brustugun OT, Gallefoss F, Falk R, Strand TE, Fjellbirkeland L. Reduced delays in diagnostic pathways for non-small cell lung cancer after local and National initiatives. Cancer Treat Res Commun 2020; 23:100168. [PMID: 32028190 DOI: 10.1016/j.ctarc.2020.100168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/06/2019] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Patients with non-small cell lung cancer (NSCLC) may experience progression and stage shift due to delays in a complex and time-consuming diagnostic work-up. We have analyzed the impact of both a local and national intervention on total time to treatment (TTT). MATERIAL AND METHODS All patients diagnosed with NSCLC at a Norwegian county hospital from 2007 to 2016 were reviewed. Logistic bottlenecks and delays were identified (2007-12) resulting in implementation of a local initiative with new diagnostic algorithm introduced by the beginning of 2013. In 2015, national diagnostic cancer pathways were implemented. TTT defined as time from received referral from the primary physician to start of treatment was compared in the three diagnostic time periods; baseline (2007-12), local (2013-14) and national (2015-16). RESULTS A total of 780 patients were included. Among patients treated with curative intent the median TTT decreased by 21 days, from 64 to 43 days (p < 0.001) while the mean number of diagnostic procedures increased from 3.5 to 3.9. In median regression analysis, the local initiative was associated with a reduction of estimated 7.8 days (95% CI 3.2, 12.3) in TTT, while the national initiative correlated with a reduction of estimated 14.9 days (95% CI 10.2, 19.6) compared to time at baseline. Covariates associated with longer TTT were stage I, use of PET-CT, diagnostic procedure at external hospital, and number of diagnostic procedures. CONCLUSION Local and national initiatives significantly reduced TTT in NSCLC. The effect was most pronounced among patients with disease available for curative treatment.
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Affiliation(s)
- Dan Laerum
- Department of Internal Medicine, Pulmonary Section, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital - Vestre Viken Hospital Trust, Drammen, Norway
| | - Frode Gallefoss
- Department of Research, Sorlandet Hospital Kristiansand, Kristiansand/Norway and Medical Faculty, University of Bergen, Bergen, Norway
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | | | - Lars Fjellbirkeland
- Department of Respiratory Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
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Zhang R, Zhu L, Cai Z, Jiang W, Li J, Yang C, Yu C, Jiang B, Wang W, Xu W, Chai X, Zhang X, Tang Y. Potential feature exploration and model development based on 18F-FDG PET/CT images for differentiating benign and malignant lung lesions. Eur J Radiol 2019; 121:108735. [DOI: 10.1016/j.ejrad.2019.108735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/11/2019] [Accepted: 10/31/2019] [Indexed: 01/08/2023]
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Abdel-Rahman O. Impact of Timeliness of Surgical Treatment on the Outcomes of Patients with Non-metastatic Non-small Cell Lung Cancer: Findings From the PLCO Trial. World J Surg 2019; 43:2927-2933. [DOI: 10.1007/s00268-019-05089-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Leiro-Fernández V, Mouronte-Roibás C, García-Rodríguez E, Botana-Rial M, Ramos-Hernández C, Torres-Durán M, Ruano-Raviña A, Fernández-Villar A. Predicting delays in lung cancer diagnosis and staging. Thorac Cancer 2019; 10:296-303. [PMID: 30605236 PMCID: PMC6360216 DOI: 10.1111/1759-7714.12950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Despite growing interest in increasing the efficiency and speed of the diagnosis, staging, and treatment of lung cancer (LC), the interval from signs and symptoms to diagnosis and treatment remains longer than recommended. The aim of this study was to analyze the factors that cause delays in the LC diagnosis/staging process and, consequently, delays in making therapeutic decisions. Methods We analyzed audit data from a prospective dataset of 1330 patients assessed at The Lung Cancer Rapid Diagnostic Unit from 26 June 2013 to 26 March 2016. The number and type of procedures and medical tests and the times of all procedures were recorded. Clinical and epidemiological variables and whether the diagnosis was performed on an inpatient or outpatient basis were also recorded. Results Malignancy was confirmed in 737 (55.4%) of the 1330 patients, with LC in 627 of these (85.2%). The mean interval to final diagnosis was 19.8 ± 13.9 days. Variables significantly related to a longer diagnostic time were the number of days until computed tomography (CT) was performed (odds ratio [OR], 95% confidence interval [CI] 1.347, 1.103–1.645; P = 0.003), until a histology sample was obtained (OR 1.243, 95% CI1.062–1.454; P = 0.007), and the total number of tests performed during the diagnostic and staging process (OR 1.823, 95% CI 1.046–3.177; P = 0.03). Conclusions A greater number of tests and more days to CT and histology led to longer delay times. Optimization of these factors should reduce delays in the LC diagnosis process.
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Affiliation(s)
- Virginia Leiro-Fernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cecilia Mouronte-Roibás
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Esmeralda García-Rodríguez
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - María Torres-Durán
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Consortium for Biomedical Research in Epidemiology & Public Health, Galicia, Spain
| | - Alberto Fernández-Villar
- Pulmonology Department, Álvaro Cunqueiro Hospital, University Hospital Complex of Vigo, NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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