P1.01-048 Factors Contributing Delays during Management of Lung Cancer: A Study from Tertiary Level Hospital in Nepal

Abstract

Lung cancer is the leading cause of cancer related morbidity and mortality in both the sexes in Nepal. It accounts for 15.4 % of total cancer as per hospital based Cancer Registry in Nepal. Majority of patients are diagnosed and treated at advanced stage. This can be partly contributed to long lag period between the onset of symptoms and the initiation of cancer treatment. This study tries to evaluate the factor contributing delays in various steps in lung cancer diagnosis and treatment. This retrospective cross-sectional observational study was conducted at Department of Clinical Oncology, Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. We reviewed the record of the all registered, histologically diagnosed lung cancer patient during the year 2012 and 2013. A total of 123 patients were diagnosed as Lung cancer and their records were evaluated. Out of these 123 patients, 60% of the cases were males. The mean age was 63.93 years with the youngest being 35 and the eldest was 83 years. Significant number of patient was in stage III (59%) and IV (33%). About 89% of the patients were smokers. Non-small cell lung cancer (NSCLC) accounted 83% and small cell lung cancer was (SCLC) 17%. A total of 17% (21) of patient were on empirical Anti-tubercular treatment (ATT) since the onset of current symptoms. While analyzing delay with independent T test showed mean delay of 25.01 days (-/+ SD 6.17) in patient without ATT and with ATT delay was 57.09 days (-/+ SD 8.05) (p=<0.01). Thirty five percentage (43) of patient received treatment within 1 month from the first hospital visit, 28% (34) within two months and 37%(46) within 3-4 months of the first hospital visit. The delay in specialist visit was shorter in advanced cancer and small cell cancer may be because of the acute presenting symptoms. Various factors contributing for the delays are lag time from symptom onset to first visit with primary physician, delay due to investigation and symptomatic treatment under primary physician care, delay further aggravated by empirical but inappropriate ATT, further delay due to diagnostic procedure to establish the cancer diagnosis. Thus proper and timely referral to the specialist from primary physician will reduce these delays and help to avoid situation where curable disease become incurable and significantly alters the prognosis.