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BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Medical complexity and time to lung cancer treatment – a three-year retrospective chart review

Authors: Trine Stokstad, Sveinung Sørhaug, Tore Amundsen, Bjørn H. Grønberg

Published in: BMC Health Services Research | Issue 1/2017

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Abstract

Background

The time from a referral for suspected lung cancer is received at a hospital until treatment start has been defined as a quality indicator. Current Norwegian recommendation is that ≥70% should start surgery or radiotherapy within 42 calendar days and systemic therapy within 35 days. However, delays can occur due to medical complexity. The aim of this study was to quantify the proportion of patients who started treatment within the recommended timeframes; and to assess the proportion of non-complex patients for which there were no good reasons for delays.

Methods

We performed a retrospective chart review of all patients diagnosed with lung cancer at a university hospital during 2011–2013. We defined “non-complex” patients as those who underwent ≤1 tissue diagnostic procedure and had no delays due to comorbidity, intercurrent disease or complications to diagnostic procedures (“Medical delays”) of more than three days.

Results

Four hundred forty-nine cases were analyzed; 142 (32%) had >1 tissue diagnostic procedures; 67 (15%) had medical delays >3 days; 262 (58%) were non-complex and 363 (81%) received treatment for lung cancer. Median number of days until surgery or radiotherapy was 48 (overall) and 41 (non-complex patients). The proportions who started surgery or radiotherapy within 42 days were 41% (overall) and 56% (non-complex). Corresponding numbers for systemic therapy were 29 days (overall) and 25 days (non-complex), and 64% (overall) and 80% (non-complex).

Conclusion

Fewer lung cancer patients than desired started treatment within the recommended timeframes. Even among the least complex patients, too few patients received timely treatment. The reasons need to be identified and understood, and changes in the organization appear to be necessary in order to offer timely treatment to more patients.
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Literature
1.
Brocken P, Prins JB, Dekhuijzen PN, van der Heijden HF. The faster the better?-A systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psychooncology. 2012;21(1):1–10.CrossRefPubMed
2.
Brocken P, van der Heijden EH, Oud KT, Bootsma G, Groen HJ, Donders AR, Dekhuijzen PN, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology. 2015;24(4):433–41.CrossRefPubMed
3.
Paul C, Carey M, Anderson A, Mackenzie L, Sanson-Fisher R, Courtney R, Clinton-McHarg T. Cancer patients’ concerns regarding access to cancer care: perceived impact of waiting times along the diagnosis and treatment journey. Eur J Cancer Care (Engl). 2012;21(3):321–9.CrossRef
4.
Probst HB, Hussain ZB, Andersen O. Cancer patient pathways in Denmark as a joint effort between bureaucrats, health professionals and politicians--a national Danish project. Health Policy. 2012;105(1):65–70.CrossRefPubMed
5.
Murray PV, O'Brien MER, Sayer R, Cooke N, Knowles G, Miller AC, Varney V, Rowell NP, Padhani AR, MacVicar D, et al. The pathway study: results of a pilot feasibility study in patients suspected of having lung carcinoma investigated in a conventional chest clinic setting compared to a centralised two-stop pathway. Lung Cancer. 2003;42(3):283–90.CrossRefPubMed
6.
Forrest LF, Adams J, Rubin G, White M. The role of receipt and timeliness of treatment in socioeconomic inequalities in lung cancer survival: population-based, data-linkage study. Thorax. 2015;70(2):138–45.CrossRefPubMed
7.
Gomez DR, Liao KP, Swisher SG, Blumenschein GR, Erasmus Jr JJ, Buchholz TA, Giordano SH, Smith BD. Time to treatment as a quality metric in lung cancer: staging studies, time to treatment, and patient survival. Radiother Oncol. 2015;115(2):257–63.CrossRefPubMed
8.
Olsson JK, Schultz EM, Gould MK. Timeliness of care in patients with lung cancer: a systematic review. Thorax. 2009;64(9):749–56.CrossRefPubMed
9.
Gould MK, Ghaus SJ, Olsson JK, Schultz EM. Timeliness of care in veterans with non-small cell lung cancer. Chest. 2008;133(5):1167–73.CrossRefPubMed
10.
Ayanian JZ, Zaslavsky AM, Arora NK, Kahn KL, Malin JL, Ganz PA, van Ryn M, Hornbrook MC, Kiefe CI, He Y, et al. Patients’ experiences with care for lung cancer and colorectal cancer: findings from the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol. 2010;28(27):4154–61.CrossRefPubMedPubMedCentral
11.
12.
Wagner EH, Aiello Bowles EJ, Greene SM, Tuzzio L, Wiese CJ, Kirlin B, Clauser SB. The quality of cancer patient experience: perspectives of patients, family members, providers and experts. Qual Saf Health Care. 2010;19(6):484–9.PubMed
13.
Jakobsen E, Green A, Oesterlind K, Rasmussen TR, Iachina M, Palshof T. Nationwide quality improvement in lung cancer care: the role of the Danish Lung Cancer Group and Registry. J Thorac Oncol. 2013;8(10):1238–47.CrossRefPubMed
14.
15.
16.
17.
18.
Ost DE, Yeung S-CJ, Tanoue LT, Gould MK. Clinical and organizational factors in the initial evaluation of patients with lung cancer: american college of chest physicians evidence-based clinical practice guidelines. Chest. 2013;143(5_suppl):e121S–41S.CrossRefPubMedPubMedCentral
19.
Vinod SK. Decision making in lung cancer - how applicable are the guidelines? Clin Oncol (R Coll Radiol). 2015;27(2):125–31.CrossRef
20.
Vinas F, Ben Hassen I, Jabot L, Monnet I, Chouaid C. Delays for diagnosis and treatment of lung cancers: a systematic review. Clin Respir J. 2016;10(3):267–71.CrossRefPubMed
21.
22.
23.
Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136(1):260–71.CrossRefPubMed
24.
Devbhandari MP, Quennell P, Krysiak P, Shah R, Jones MT. Implications of a negative bronchoscopy on waiting times to treatment for lung cancer patients: results of a prospective tracking study. Eur J Cardiothorac Surg. 2008;34(3):479–83.CrossRefPubMed
25.
Verma A, Lim AY, Tai DY, Goh SK, Kor AC, Dokeu Basheer AA, Chopra A, Abisheganaden J. Timeliness of Diagnosing Lung Cancer: Number of Procedures and Time Needed to Establish Diagnosis: Being Right the First Time. Medicine (Baltimore). 2015;94(29):e1216.CrossRef
26.
Navani N, Nankivell M, Lawrence DR, Lock S, Makker H, Baldwin DR, Stephens RJ, Parmar MK, Spiro SG, Morris S, et al. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial. Lancet Respir Med. 2015;3(4):282–9.CrossRefPubMedPubMedCentral
27.
Salomaa ER, Sallinen S, Hiekkanen H, Liippo K. Delays in the diagnosis and treatment of lung cancer. Chest. 2005;128(4):2282–8.CrossRefPubMed
28.
Seda G, Stafford CC, Parrish JS, Praske SP, Daheshia M. Chronic obstructive pulmonary disease and vascular disease delay timeliness of early stage lung cancer resectional surgery. COPD. 2013;10(2):133–7.CrossRefPubMed
29.
Hermens RP, Ouwens MM, Vonk-Okhuijsen SY, van der Wel Y, Tjan-Heijnen VC, van den Broek LD, Ho VK, Janssen-Heijnen ML, Groen HJ, Grol RP, et al. Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: a first step toward implementing a multidisciplinary, evidence-based guideline. Lung Cancer. 2006;54(1):117–24.CrossRefPubMed
30.
Alsamarai S, Yao XP, Cain HC, Chang BW, Chao HH, Connery DM, Deng YH, Garla VN, Hunnibell LS, Kim AW, et al. The effect of a lung cancer care coordination program on timeliness of care. Clin Lung Cancer. 2013;14(5):527–34.CrossRefPubMed
31.
Powell AA, Schultz EM, Ordin DL, Enderle MA, Graham BA, Partin MR, Gould MK. Timeliness across the continuum of care in veterans with lung cancer. J Thorac Oncol. 2008;3(9):951–7.CrossRefPubMed
32.
33.
34.
35.
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403.CrossRefPubMed
36.
37.
38.
Dalton SO, Frederiksen BL, Jacobsen E, Steding-Jessen M, Osterlind K, Schuz J, Osler M, Johansen C. Socioeconomic position, stage of lung cancer and time between referral and diagnosis in Denmark, 2001–2008. Br J Cancer. 2011;105(7):1042–8.CrossRefPubMedPubMedCentral
39.
Walters S, Maringe C, Coleman MP, Peake MD, Butler J, Young N, Bergström S, Hanna L, Jakobsen E, Kölbeck K, et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004–2007. Thorax. 2013;68(6):551–64.CrossRefPubMed
Metadata
Title
Medical complexity and time to lung cancer treatment – a three-year retrospective chart review
Authors
Trine Stokstad
Sveinung Sørhaug
Tore Amundsen
Bjørn H. Grønberg
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1952-y

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