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Proportions that received timely lung cancer treatment. Distributions of timely and not timely treatment in non-complex versus complex, curative versus palliative treatment, and having a PET CT versus no PET CT
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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. Th...
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PURPOSE
The COVID-19 pandemic has posed significant pressures on healthcare systems, raising concern that related care delays will result in excess cancer-related deaths. Because data regarding the impact on patients with breast cancer are urgently needed, we aimed to provide a preliminary estimate of the impact of COVID-19 on time to treatment ini...
Background:
The IMPACT UC I study assessed real-world treatment patterns, outcomes, healthcare resource utilization (HCRU), and costs in patients with metastatic urothelial carcinoma (mUC) receiving first-line (1L) systemic treatment after the FDA approval of 1L immune checkpoint inhibitor (ICI) monotherapy.
Patients and methods:
This retrospect...
Citations
... Timely LC care metrics vary between healthcare organizations, but it is generally accepted that there are justified reasons for delay for a specific proportion of patients. These reasons can include the complexity of diagnostic procedures, presence of co-morbidities and poor performance status and a patient's decision to have breaks between diagnosis procedures or before treatment initiation [25]. Our analysis showed that only 43.3% of patients received TT, with median timeto-treatment of 49 days (IQR: 28-88) worse than in other publications that reported TT rates of 77.5% (9) and 80% [23]. ...
Background:
Timeliness of care is an important dimension of healthcare quality but it's unclear whether it improves clinical outcomes in lung cancer (LC) patients.
Objectives:
This study aims to analyze treatment patterns, time-to-treatment (TTT) and the impact of treatment timeliness (TT) in overall survival (OS) of patients diagnosed with LC in 2009-2014 in a population-based registry from Southern Portugal.
Materials and methods:
We estimated median TTT for overall population, treatment type and stage. The impact of treatment and TT on five-year OS was analyzed using the Kaplan-Meier method and Cox regression modelling to determine the hazard ratio (HR) of death associated with treatment and TT.
Results:
From the 11,308 cases diagnosed, 61.7% received treatment. Treatment rate decreased with increasing stage from 88% in stage I to 66.1% in stage IV. Overall median TTT was 49 days (IQR: 28-88) and 43.3% received TT. Surgery had a longer TTT than radiotherapy and systemic treatment. Patients in earlier stages had lower TT rates and longer TTT compared to more advanced, 24.7% and 80 days in stage I versus 51.3% and 42 days in stage IV (p < 0.0001). OS was 14.9% for total population and 19.6% and 7.1% for patients with and without treatment registered, respectively. TT had no observed impact on OS for stages I/II but a negative effect for stages III/IV. Relative to treated, the adjusted mortality risk was higher in untreated patients (HR = 2.240; 95%CI: 2.293-2.553). Contrary to treatment, TT had a negative impact on survival, with 11.3% in timely vs. 21.5% in untimely treated. Compared to untimely treated, the risk of death in TT patients was 46.6% higher (HR = 1.465; 95%CI: 1.381-1.555).
Conclusions:
LC survival is highly dependent on early diagnosis and adequate treatment. Time-to-treatment was longer than recommended for all treatment types but particularly for surgery. Overall TT results were paradoxical, as better survival was observed in patients untimely treated. The factors associated with TT were not possible to analyze and its impact on patient outcomes remains unclear. However, it is important to assess quality-of-care to improved LC management.
... Both types are tested in a similar manner involving conventional chest radiography, computed tomography (CT), magnetic resonance (MR) and positron emission tomography (PET) [4]. In majority of the cases, both types of lung cancer are diagnosed in the later stage due to complex diagnostic work up, which could decrease the chance of survival [5]. ...
... The median time from incidence date to surgery was 26 days, comparing favorably to other countries. 15,[40][41][42] This short delay can be explained by the high density of surgical centers, which is however not a quality guarantee. Indeed, between 2010 and 2011, a total of 89 hospitals performed lung cancer surgery, but most were low-volume centers, half of them performing less than 10 and only nine performing at least 40 annual procedures. ...
... In the cancer setting, they have shown to improve aspects in quality of care including health-related quality of life, treatment outcomes and patient satisfaction. 58 Future efforts should continue to focus on this important aspect of care. ...
... In Norway, recommended timeframes from receiving a referral letter for suspected lung cancer until the start of treatment are 35 calendar days for systemic cancer therapy and 42 days for surgery and radiotherapy. We found that the proportions at our hospital of patients who started lung cancer treatment within recommended timeframes were 35% for curative and 65% for palliative treatment (33). In the present study, the aim was to investigate whether patients who started treatment within these timeframes had longer survival than those who started treatment later. ...
... We performed a retrospective review of the individual electronic medical records of all patients who were diagnosed with lung cancer at the Department of Thoracic Medicine at St. Olav's hospital between January 1, 2011 until December 31, 2013. Further details of the conduct of the study were presented in a previous article (33). Stage of disease was assessed according to the seventh edition of the TNM classification of lung cancer (34). ...
... It does, however, provide valuable information about the potential impact of reducing the diagnostic workup time. As we have previously reported (33), there is a large heterogeneity with respect to what kind and number of procedures are required before the diagnostic workup is completed in patients with lung cancer. Furthermore, some patients need treatment for concomitant diseases, indicating that the timeframes cannot and should not always be met. ...
Background:
Time-to-treatment is defined as a quality indicator for cancer care but is not well documented. We investigated whether meeting Norwegian timeframes of 35/42 days from referral until start of chemotherapy or surgery/radiotherapy for lung cancer was associated with survival.
Patients and methods:
The medical records of 439 lung cancer patients at a regional cancer center were reviewed and categorized according to treatment: (i) surgery; ii) radical radiotherapy; iii) stereotactic radiotherapy; iv) palliative treatment, no cancer symptoms; v) palliative treatment with severe cancer symptoms).
Results:
Proportions receiving timely treatment varied significantly at 39%, 48%, 10%, 44% and 89%, respectively (p<0.001). Overall, those starting treatment on time had the shortest median overall survival (10.6 vs. 22.6 months; p<0.001). This was also the case for palliative (5.3 vs. 11.4 months) (p<0.001) but not for curative treatment (not reached vs. 38.3 months) (p=0.038).
Conclusion:
Timely treatment is not necessarily associated with improved survival.
... As another optimal care indicator, timeliness of care was used in previous studies (Freeman et al., 1995;Olsson et al., 2009;Stokstad et al., 2017). For this matter, intervals between different time points along the patient's care trajectory, for example, the time interval between dates of diagnosis and start of treatment, are measured and shorter time intervals are usually considered as more advantageous for the patient (Olsson et al., 2009;Stokstad et al., 2017). ...
... As another optimal care indicator, timeliness of care was used in previous studies (Freeman et al., 1995;Olsson et al., 2009;Stokstad et al., 2017). For this matter, intervals between different time points along the patient's care trajectory, for example, the time interval between dates of diagnosis and start of treatment, are measured and shorter time intervals are usually considered as more advantageous for the patient (Olsson et al., 2009;Stokstad et al., 2017). ...
... For this investigation, we used timeliness of care as outcome that was previously used as an indicator for optimal care (Olsson et al., 2009;Stokstad et al., 2017). In the present study, we assume that a timelier diagnosis and a timelier start of a treatment are preferable F I G U R E 1 Flow chart illustrating exclusion of observations from initial dataset according to previously described exclusion criteria. ...
Objectives
Several patient factors have been described to influence access to optimal cancer care like socioeconomic factors or place of residence. In this study, we investigate whether data routinely collected in a clinical cancer registry can be used to identify populations of lung cancer patients with increased risk of not receiving optimal cancer care.
Methods
We analysed data of 837 lung cancer patients extracted from the clinical cancer registry of a German university hospital. We compared patient populations by two indicators of optimal care, namely implementation of tumour board meeting recommendations as well as the timeliness of care.
Results
There was a high rate of implementation of tumour board meeting recommendations of 94.4%. Reasons for non‐implementation were mainly a patient's own wish or a worsening of the health situation. Of all patient parameters, only tumour stage was associated with the two optimal care indicators.
Conclusion
Using routine data from a clinical cancer registry, we were not able to identify patient populations at risk of not getting optimal care and the implementation of guideline‐conform care appeared to be very high in this setting. However, limitations were the ambiguity of optimal care indicators and availability of parameters predictive for patients’ vulnerability.
... A distinguishing attribute of the LCEC program is the inclusion of a patient navigator and nurse practitioners who assist with addressing many of the complex needs experienced by lung cancer patients [29][30][31]. The high degree of psychological morbidity among this group of cancer patients increases the need for close monitoring and additional evaluation [32]. ...
Introduction
Lung cancer is the leading cause of cancer death in the USA, claiming more than 140,000 deaths annually. Delays in diagnosis and treatment can lead to missed opportunities for both curative and life prolonging therapies. This study aimed to evaluate duration of time to diagnosis and first treatment, as well as investigate reasons for delays in care.
Methods
This retrospective study included all lung cancer cases diagnosed by Stony Brook’s Lung Cancer Evaluation Center (LCEC) between 2013 and 2019. Demographic, radiologic, pathologic and clinical variables were investigated, including cancer staging, histology, and medical and family histories. Evaluations included the determination of median time from initial encounter to diagnosis, median time from diagnosis to start of treatment and an exploration of the factors that influence possible causes for delays in care.
Results
The LCEC’s comprehensive multidisciplinary lung nodule program yielded a median length of time from CT to PET of 11 days, PET to procedure of 13 days, procedure to treatment consult of 9 days, and from consult to treatment of 9 days. LCEC patients experienced an overall median of 44 days from initial presentation to first treatment compared to the national ideal of 62 days, thereby representing a 29% reduction in time from first CT to onset of treatment.
Conclusion
Delays in lung cancer diagnosis and treatment can negatively impact patient morbidity and mortality. This study suggests that a coordinated multidisciplinary lung cancer program may reduce delays in care, thereby improving patient outcomes.
... In addition, only a low proportion of patients have mutation test results available at their first oncology consultation, resulting in delayed initiation of therapy or initiation of chemotherapy before diagnostic test results are available 13 . The causes of suboptimal mutation assessment are multifactorial, including patient comorbidities, complications of lung biopsy such as bleeding, pneumothorax, and infection, and frequently inadequate sampling leading to costly rebiopsy in about a third of patients 15,16 . Furthermore, increasing understanding of tumor heterogeneity calls into question the representativeness of a biopsy of a single metastatic site 17,18 . ...
Molecular testing for genomic variants is recommended in advanced non-small cell lung cancer (NSCLC). Standard tissue biopsy is sometimes infeasible, procedurally risky, or insufficient in tumor tissue quantity. We present the analytical validation and concordance study of EGFR variants using a new 17-gene liquid biopsy assay (NCT02762877). Of 144 patients enrolled with newly diagnosed or progressive stage IV nonsquamous NSCLC, 140 (97%) had liquid assay results, and 117 (81%) had both EGFR blood and tissue results. Alterations were detected in 58% of liquid samples. Overall tissue-liquid concordance for EGFR alterations was 94.0% (95% CI 88.1%, 97.6%) with positive percent agreement of 76.7% (57.7%, 90.1%) and negative percent agreement of 100% (95.8%, 100%). Concordance for ALK structural variants was 95.7% (90.1%, 98.6%). This assay detected alterations in other therapeutically relevant genes at a rate similar to tissue analysis. These results demonstrate the analytical and clinical validity of this 17-gene assay.
... These drawbacks mainly emerge from the invasive nature of the used procedures, such as bronchoscopy, endobronchial ultrasound with transbronchial needle aspiration, or percutaneous computed tomography-guided transthoracic lung biopsy-techniques that require expertise and operator skills and, importantly, always coincide with considerable patient discomfort and sometimes serious complications. For lung cancer patients with inaccessible lesions or substantial comorbidity, tissue examination might be delayed or simply not possible [7]. ...
Background:
Accurate lung cancer classification is crucial to guide therapeutic decisions. However, histological subtyping by pathologists requires tumor tissue-a necessity that is often intrinsically associated with procedural difficulties. The analysis of circulating tumor DNA present in minimal-invasive blood samples, referred to as liquid biopsies, could therefore emerge as an attractive alternative.
Methods:
Concerning adenocarcinoma, squamous cell carcinoma, and small cell carcinoma, our proof of concept study investigates the potential of liquid biopsy-derived copy number alterations, derived from single-end shallow whole-genome sequencing (coverage 0.1-0.5×), across 51 advanced stage lung cancer patients.
Results:
Genomic abnormality testing reveals anomalies in 86.3% of the liquid biopsies (16/20 for adenocarcinoma, 13/16 for squamous cell, and 15/15 for small cell carcinoma). We demonstrate that copy number profiles from formalin-fixed paraffin-embedded tumor biopsies are well represented by their liquid equivalent. This is especially valid within the small cell carcinoma group, where paired profiles have an average Pearson correlation of 0.86 (95% CI 0.79-0.93). A predictive model trained with public data, derived from 843 tissue biopsies, shows that liquid biopsies exhibit multiple deviations that reflect histological classification. Most notably, distinguishing small from non-small cell lung cancer is characterized by an area under the curve of 0.98 during receiver operating characteristic analysis. Additionally, we investigated how deeper paired-end sequencing, which will eventually become feasible for routine diagnosis, empowers tumor read enrichment by insert size filtering: for all of the 29 resequenced liquid biopsies, the tumor fraction could be increased in silico, thereby "rescuing" three out of five cases with previously undetectable alterations.
Conclusions:
Copy number profiling of cell-free DNA enables histological classification. Since shallow whole-genome sequencing is inexpensive and often fully operational at routine molecular laboratories, this finding has current diagnostic potential, especially for patients with lesions that are difficult to reach.
... There is also a limited level of clinical details provided by the registers, e.g., regarding treatments initiated outside the specialised health care system, including oral therapy. Moreover, unadjusted local variation in waiting times within regions, differences in medical complexity, or a mixture of cancer subtypes are also possible explanations for the observed findings [5,12]. Variations in the mean age at diagnosis, comorbidities, income and education level were observed, which may hamper the comparison between the various populations. ...
