Contributing factors for diagnostic delays in advanced lung cancer (LC) patients and the role of multidisciplinary tumor board (MTB) discussion in a community hospital setting.
2014; Lippincott Williams & Wilkins; Volume: 32; Issue: 15_suppl Linguagem: Inglês
10.1200/jco.2014.32.15_suppl.e17592
ISSN1527-7755
AutoresRajitha Sunkara, Aixa Soyano, Samaan Rafeq, Leslie Martin, David D. Lee, Dorcas Chi,
Tópico(s)Lung Cancer Treatments and Mutations
Resumoe17592 Background: The median delay from symptoms to treatment initiation (TI) for LC patients is 3-6 months, which is a significant stressor for newly diagnosed. The contributing factors remain uncertain. Methods: We retrospectively reviewed small cell lung cancer (SCLC) and stage III/IV non small cell lung cancer (NSCLC) patients between 2009 and 2013 at St. Elizabeth Medical Center, Boston. We studied the lag periods from initial diagnostic imaging (IDI) with CT/MRI to TI for and investigated the underlying reasons. Time intervals were summarized using mean, standard deviation, median and IQR and compared between patient groups using t-test. Results: We identified 80 evaluable patients. Median interval from IDI to TI is 28 days (Table). PET/CT is identified as one of the modifiable contributing factors in metastatic disease. 52/80 had PET/CT for staging but only 5/52 (9%) had treatment change. 47/80 had IDI suggestive of metastases (SCLC and NSCLC). 30/47 had PET/CT for confirmation without change of treatment planning.The median delay from IDI to TI in 30/47 is 28 days compared to 13 days in the 17/47 without PET/CT (P=0.01). This delay is even higher for 8/30, who had additional biopsies after PET/CT at 58.5 days. 64/80 had MTB discussion. 56/64 had MTB before TI with a median interval of 19 days from IDI to MTB discussion. In these 56, the interval from IDI to TI was 33.5 days. Conclusions: Our data questions the role of PET/CT in patients, whose IDI supports metastases. Also there is a need for early utilization of MTB to optimally sequence the tests and avoid unnecessary delays. N Mean ± SD Median IQR T-test All patients 80 32.0 ± 21.8 28 15.5 - 47 Specialty Pulm 44 34.5 ± 20.2 30 21 - 46 IR/CT surgery 36 28.9 ± 23.5 23 9 – 48.5 P=0.2558 Inpatient vs. out Inpatient 45 23.8 ± 17.9 23 11 - 31 Outpatient 35 42.5 ± 22.2 40 23 - 58 P<0.0001 PET Y (before Tx) 52 38.2 ± 21.4 31 23 - 53 N (No or after Tx) 28 20.4 ± 17.9 15.5 5 – 29.5 P=0.0003 Type of cancer Non-small 62 35.3 ± 22.3 30 21 - 49 Small 18 20.7 ± 16.2 15.5 7 - 31 P=0.0119 For non-small CA Original stg 3 22 44.7 ± 18.9 39.5 30 - 52 Original stg 4 39 30.0 ± 22.8 25 13 - 47 P=0.0130 Final stg 3 20 46.0 ± 18.9 39.5 32 - 56.5 Final stg 4 42 30.2 ± 22.1 25.5 13 - 47 P=0.0080
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