Chest
Volume 128, Issue 4, October 2005, Pages 2282-2288
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Clinical Investigations
Delays in the Diagnosis and Treatment of Lung Cancer

https://doi.org/10.1378/chest.128.4.2282Get rights and content

Study objectives

This study was undertaken to measure delays of diagnosis and to assess the causes for those delays in patients with lung cancer. In addition, the relation of delay times and survival was analyzed.

Design

A retrospective study based on patient records. Dates for symptoms, visits to doctors, investigations, treatment, and death were recorded.

Setting

Patients who were found to have lung cancer at Turku University Hospital, Finland, during 2001.

Patients

Records of 132 patients were reexamined.

Results

The median delay in patient presentation from first symptoms to first appointment with a general practitioner (GP) was 14 days. The median delay by the GP before writing a referral was 16 days, the median referral delay was 8 days, the median delay from the first visit to a specialist until the diagnosis was 15 days, and the median treatment delay was also 15 days. Thirty percent of patients received treatment within 1 month from the first hospital visit, and 61% received treatment within 2 months. The median symptom-to-treatment delay was almost 4 months. The delay in seeing a specialist was shorter in patients with advanced cancer and small cell lung cancer. About half of our patients fulfilled the criteria of the British Thoracic Society recommendations. A longer specialist treatment delay seemed to correlate with better survival in advanced disease, but it was not an independent significant factor for survival.

Conclusions

Several reasons for long delays were found, but on many occasions patients underwent numerous consecutive procedures before a diagnosis of cancer was confirmed. Shortening the diagnostic and treatment delay times might be possible with little extra cost by a multidisciplinary team approach and by rapid access to carefully planned investigations, but decreasing the patient delay might be more difficult. This study shows that long specialist treatment delays are not correlated with worse prognosis in patients with advanced disease. In patients with more limited disease, the delay time may be more critical, and if curative treatment is the goal, the diagnostic process should proceed without needless delay to avoid a situation in which curable disease becomes incurable.

Section snippets

Materials and Methods

The Finnish health-care system is based on public primary health care (general practitioners [GPs]) and on specialist health care in hospitals. Access to primary health care is easy, but in public health care a visit to a specialist is possible only by referral. The government covers the majority of the costs of health care. The district of Turku University Hospital consists of 58 municipalities that have their own health centers and a population of about 453,000 people. It is the only hospital

Results

Altogether, 133 new lung cancers were found. One patient record was not found, so 132 patients were included in this study. Of these, 95 patients (72%) were men, and the mean age of all patients was 69 years (Table 1). In total, 44 of the lung cancers (33%) were in the operable stage, and 25 patients (19% of all patients; 23% of patients with non-small cell lung cancer [NSCLC]) were operated on. The main reason for inoperability after the cancer was in the advanced stage was poor lung function.

Discussion

Studies calculating the growth of lung tumors based on mathematical models suggest that it takes 10 to 15 years from the appearance of the first cancer cell to the possibility of detecting a NSCLC by conventional chest radiograph. This indicates that the growth of a tumor is slow, and it seems unlikely that the prognosis is changed by the delay time of diagnosis. The time observed for lung tumors to double their volume ranges from 4 to 56 weeks, with a median time of 17 weeks.1011 With the

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