Non small cell lung cancer: Do delays in diagnosis and treatment affect outcome

Abstract

17559 Background: Delay in management of patients with non-small cell lung cancer (NSCLC) may reduce survival and quality of life. However, the minimal acceptable time delay from suspicion to treatment and factors affecting delay has not been determined. Methods: All patients with NSCLC between February 1999 and December 2005 at the Hines VA were identified and specific key dates during each patient's management course were recorded. The outcome events were death and type of intervention: definitive surgery or palliation. A retrospective cohort analysis was performed. Given a difference in expected survival based upon the disease stage we stratified patients into two groups: one group composed of patients with stage I/II disease and the other group with stage III/IV disease. Within each stratum we conducted univariate and multivariate analysis by determining the relative risk for the chosen outcome based upon the presence or absence of several potential predictors of outcome: age, race, co-morbidities (Charleson Index), presence or absence of a primary care provider and substance abuse. Results: The relative risk of death with stage I/II disease diagnosed ≤ 30 days compared to > 30 days was 0.75 (95% CI: 0.40 -1.46) and was 1.72 (95% CI: 1.28–2.31) for those with stage III/IV. The Charleson index (1–2) was associated with reduced survival (RR=1.52; 95% CI: 1.03–2.27). Lack of a primary care physician was associated with worse survival (RR=1.55; 95% CI: 1.09–1.58). Conclusions: Timely diagnosis in patients with late stage disease, patient morbidity and lack of a primary care physician was associated with worse survival. No significant financial relationships to disclose.