The pathway to diagnosis and treatment for surgically managed lung cancer patients

Victoria White; Rebecca J Bergin; Robert J Thomas; Kathryn Whitfield; David Weller

doi:10.1093/fampra/cmz064

The pathway to diagnosis and treatment for surgically managed lung cancer patients

Fam Pract. 2020 Mar 25;37(2):234-241. doi: 10.1093/fampra/cmz064.

Authors

Victoria White^{1

2}, Rebecca J Bergin^{3

4}, Robert J Thomas^{5

6}, Kathryn Whitfield⁶, David Weller⁷

Affiliations

¹ School of Psychology, Deakin University, Burwood, Australia.
² Centre for Behavioural Research in Cancer, Melbourne, Australia.
³ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
⁴ Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
⁵ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
⁶ Department of Health and Human Services Victoria, Victorian Government, Melbourne, Australia.
⁷ Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.

PMID: 31665265
DOI: 10.1093/fampra/cmz064

Abstract

Background: Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis.

Methods: Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age.

Results: One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant.

Conclusion: Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

Keywords: Early diagnosis; health services research; lung neoplasms; survival; time factors; time to treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Benchmarking
Cross-Sectional Studies
Delayed Diagnosis / statistics & numerical data*
Early Detection of Cancer
Female
Humans
Lung Neoplasms / diagnosis*
Lung Neoplasms / mortality
Lung Neoplasms / surgery*
Male
Middle Aged
Primary Health Care / statistics & numerical data*
Referral and Consultation
Registries
Surveys and Questionnaires
Survival Analysis
Time Factors
Time-to-Treatment / statistics & numerical data*
Victoria / epidemiology