Abstract 1997
Background
Multiple clinical practice guidelines recommend rapid evaluation of patients with suspected lung cancer. It is uncertain if delays in diagnosis and management have a negative effect on outcomes.
Methods
This retrospective review included 551 patients diagnosed with lung cancer through the Rapid Diagnostic Assessment Program at Institut Universitaire de Cardiologie et de Pneumologie de Québec between September 2013 and March 2015. Median wait times between initial referral, diagnosis and first treatment were calculated and compared with recommended targets. Analyses were performed for effect of delays on the outcomes of progression-free survival (PFS) and overall survival (OS).
Results
Most patients were investigated and treated within recommended targets, as shown in Table 1. Among the entire cohort, 379 patients were treated at our institution. Of these, 289 (76%) commenced their treatment within recommended targets. When comparing patients meeting targets with patients not meeting targets, the only statistically significant difference was treatment modality. Patients meeting targets were more likely to be treated with surgery, as opposed to radiation or chemotherapy. PFS on first treatment modality was influenced by TNM stage and diagnostic method. There was also a trend for improved PFS if the treatment was commenced within targets (HR 0.85, CI 0.58-1.24, p = 0.07). OS was influenced by TNM stage and first treatment modality, but was not affected by delays (HR 0.84, CI 0.56-1.27, p = 0.41).
– Median wait times for investigation and treatment
| Relative wait times from: | Recommended target, days | Median time, days (IQR) | Patients within target, No. (%) |
|---|---|---|---|
| Investigation (n = 551) | |||
| Referral to first appointment (n = 551) | 14 | 6 (4-10) | 461 (84%) |
| Referral to chest computed tomography scan (n = 189) | 14 | 5 (1-7) | 174 (92%) |
| Biopsy to pathology result (n = 551) | 14 | 3 (2-4) | 550 (99.8%) |
| Request for EGFR and ALK testing to result (n = 172) | 14 | 5 (3-6) | 169 (98%) |
| Treatment (n = 379) | |||
| Respirology consultation to time of surgery (n = 210) | 56 | 59 (41-80) | 100 (48%) |
| Operative decision to time of surgery (n = 210) | 28 | 8 (2-21) | 180 (86%) |
| Surgery to commencing adjuvant chemotherapy (n= 42) | 120 | 44 (36-55) | 41 (98%) |
| RO referral to RO consultation (n = 211) | 7 | 4 (2-7) | 166 (79%) |
| RO referral to commencing definitive radiation (n = 67) | 28 | 26 (22-35) | 42 (63%) |
| Diagnosis to commencing definitive chemoradiation (n = 48) | 180 | 27 (13-34) | 48 (100%) |
| RO referral to commencing palliative radiation (n = 96) | 14 | 8 (6-16) | 69 (72%) |
| Decision for chemotherapy to commencing chemotherapy (n = 117) | 7 | 6 (4-8) | 79 (68%) |
IQR: interquartile range; EGFR: epidermal growth factor receptor; ALK: anaplasic lymphoma kinase; RO: radiation oncology
Conclusions
Recommended targets for wait times in the investigation and treatment of lung cancer can be achieved with a Rapid Diagnostic Assessment Program. Patients treated with surgery, as compared to radiation or chemotherapy, are more likely to be treated within targets. Shorter delays might have a favorable influence on PFS, but has no effect on OS.
Clinical trial identification
Legal entity responsible for the study
Institut Universitaire de Cardiologie et de Pneumologie de Québec
Funding
N/A
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
ZUMA-3: A phase 1/2 multi-center study evaluation the safety and efficacy of KTE-C19 anti-CD19 CAR T cells in adult patients with relapsed/refractory B precursor acute lymphoblastic leukemia (R/R ALL)
Presenter: Bijal Shah
Session: Poster display
Resources:
Abstract
ZUMA-2: A phase 2 multi-center study evaluating the efficacy of KTE-C19 (Anti-CD19 CAR T cells) in patients with relapsed/refractory Mantle cell lymphoma (R/R MCL)
Presenter: Michael Wang
Session: Poster Display
Resources:
Abstract
ZUMA-1: A phase 2 multi-center study evaluating anti-CD19 chimeric antigen receptor (CAR) T cells in patients with refractory aggressive non-Hodgkin lymphoma (NHL)
Presenter: Sattva Neelapu
Session: Poster Display
Resources:
Abstract
Younger age as a prognostic indicator in breast cancer: Correlation between clinical-pathologic factors and miRNAs and long-term follow-up
Presenter: Maria Teresa Martinez
Session: Poster display
Resources:
Abstract
Window study of the PARP inhibitor rucaparib in patients with primary triple negative or BRCA1/2 related breast cancer (RIO)
Presenter: Christy Toms
Session: Poster display
Resources:
Abstract
Whole exome sequencing (WES) and RNA sequencing (RNA-seq) in routine clinical practice for colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) patients (pts)
Presenter: Géraldine Perkins
Session: Poster display
Resources:
Abstract
What is the optimal annual interpretive volume for a radiologist reading screening mammograms?
Presenter: Asli Uluturk
Session: Poster display
Resources:
Abstract
What decides breast conservation versus mastectomy in the background of diverse sociocultural environment, an Indian study
Presenter: Poonamalle Padmanabhan Bapsy
Session: Poster display
Resources:
Abstract
Waiting time to diagnosis and treatment of the head and neck cancer in four institutions in Portugal
Presenter: Ana Castro
Session: Poster display
Resources:
Abstract
VISMONEO - a phase II study assessing vismodegib in the neoadjuvant treatment of locally advanced basal cell carcinoma - Patients characteristics
Presenter: Nicole Basset-Seguin
Session: Poster display
Resources:
Abstract