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OA17 - Aspects of Health Policies and Public Health (ID 397)
- Event: WCLC 2016
- Type: Oral Session
- Track: Regional Aspects/Health Policy/Public Health
- Presentations: 1
OA17.07 - Time from the Identification of a Suspicious Pulmonary Lesion to the Treatment of Non-Small Cell Lung Cancer (ID 4069)
16:00 - 17:30 | Author(s): C. Hiles
Despite guideline recommendations on time intervals in the care of a lung cancer patient, delays are often experienced. The goal of this study was to quantify time intervals and identify delays in the workup to treatment of non-small cell lung cancer (NSCLC) at our institution.
A retrospective review of all NSCLC cases in the Tumor Registry at a tertiary military medical center diagnosed and treated between July 2011 and July 2014 was performed. Dates of radiographic identification of a suspicious pulmonary lesion, tissue diagnosis, evaluation by the treating specialist, and initial treatment (whether surgery, radiation, chemotherapy, or best supportive care/palliative care) were recorded. Time intervals were calculated from these dates; if any interval was more than 60 days, reasons for delays were recorded.
The median time from the identification of a suspicious pulmonary lesion to the treatment of NSCLC was 74 days (range 5-557 days) and the median time from tissue diagnosis to first treatment was 33 days (range 1-252 days) for the 148 patients included in the analysis. Even after excluding outliers, the adjusted median time from the identification of a suspicious pulmonary lesion to the treatment was 71 days. The most common reasons for treatment delay were waiting for consultant evaluations, staging procedures, repeat biopsies, or additional studies (pre-operative risk stratification, molecular testing). Only 1 patient was upstaged from time of tissue diagnosis to first treatment (from IA to IIB following resection).
Table 1: Critical time intervals
Time interval Median Range Days from suspicious imaging study to first treatment 74 5-557 Days from suspicious imaging study to tissue diagnosis 34 1-556 Days from suspicious imaging study to evaluation by treating specialist 50 1-553 Days from tissue diagnosis to first treatment 33 1-252 Days from tissue diagnosis to evaluation by treating specialist Cardiothoracic surgery Radiation-oncology Medical-oncology Palliative care 20 21 21 18 15 1-157 10-56 1-157 1-64 4-48 Days from evaluation by treating specialist to first treatment Surgery Radiation Chemotherapy Best supportive care 16 23 14 16 1 1-261 6-261 1-88 1-28 1-28
Several time intervals identified in the workup to initial treatment of NSCLC patients at our institution exceeded recommendations from various guidelines. These delays could be addressed with process and quality improvement projects involving a standardized NSCLC clinical care pathway.
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