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Treatment delays, missed diagnostic testing common among patients with lung cancer
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Patients who undergo surgery for lung cancer may experience treatment delays and forgo diagnostic processes that would help determine their optimal treatment plan, according to results of a retrospective analysis.
Raymond U. Osarogiagbon, MBBS, FACP, a research professor at University of Memphis School of Public Health and director of the multidisciplinary thoracic oncology program at Baptist Cancer Center in Memphis, and colleagues found that the appropriate steps for the optimal care of patients with lung cancer — which includes efficient passage from the point of initial identification of a lesion, through diagnosis, staging and treatment — are often not taken.
“It takes too long for patients who have suspected lung cancer to get final treatment and too many patients skip vital steps needed to decide the best possible treatment,” Osarogiagbon said in a press release. “This delay in treatment can cause the cancer to advance and reduce the odds of survival for the patient.”
The researchers retrospectively reviewed clinical records of 614 patients who received a lung resection at two Memphis institutions and classified the lung cancer procedures into five steps: lesion detection, diagnostic biopsy, radiologic staging, invasive staging and treatment. Researchers analyzed the frequency of each step, the time interval between each step and the use of staging modalities.
Ninety-two percent of the cohort had lung cancer, 5% had a non-long primary tumor and 3% had a benign lesion.
Overall, 27% of the cohort had no preoperative diagnostic procedure, 22% did not undergo imaging to determine cancer stage and 88% did not have an invasive preoperative staging test.
Further, only 10% of the patients received the recommended trimodality staging with CT, PET/CT and invasive staging before undergoing the surgery.
Additionally, the data indicate that it took more than 6 months in some instances (median 84 days; interquartile range, 43-189) for patients to undergo surgery following the initial signs of possible lung cancer.
“Lung cancer care is complicated and all key specialists must be actively engaged early on with each patient to determine the best sequence of tests and treatment for each individual,” Osarogiagbon said in the release. “Programs that provide treatment for lung cancer also must measure their performance actively and carefully in order to improve the quality of care and improve patients’ chances of survival.”
Osarogiagbon and colleagues noted that they are creating a multidisciplinary team of thoracic oncology experts and systems engineers that will include a group clinic where surgeons, pulmonologists and oncologists can interact with patients in an environment with live radiology support.
They wrote that they will prospectively measure process-of-care benchmarks and that an analysis of surgical and non-surgical care will allow for the investigators to identify factors associated with any deviation from the optimal care protocol.
Farhood Farjah, MD, MPH, assistant professor of surgery at University of Washington and associate medical director of the surgical outcomes research center (SORCE), supported the conceptualization of the researchers plan to fix this problem in an accompanying editorial.
“There are significant gaps in the quality of lung cancer care,” Farjah wrote. “Moving ‘proximally’ towards a disease-based approach to quality improvement allows for such efforts to better realize their potential of positively influencing individuals and the general population.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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