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.
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).
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
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
All authors have declared no conflicts of interest.