Timeliness of care and stage at diagnosis of non-small cell lung cancer (NSCLC) with the implementation of a cancer care coordination program (CCCP) at a VA medical center.

Abstract

6033 Background: Timeliness of care improves patient satisfaction and may improve outcomes. A CCCP was established in Nov 2007 to improve timeliness of care of NSCLC patients at the Veterans Affairs Connecticut (VACT) Healthcare System. Methods: We performed a retrospective cohort analysis of patients diagnosed with NSCLC at VACT between 2005-2010. We compared timeliness of care and stage at diagnosis before and after the implementation of the CCCP. Results: Data from 352 patients was analyzed: 163 with initial abnormal imaging between 1/1/2005 and 10/31/2007, and 189 with imaging between 11/1/2007 and 12/31/2010. Variables associated with a longer interval between the initial abnormal image and the initiation of therapy were: (1) earlier stage (mean of 130 days for stages I/II vs. 87 days for stages III/IV, p<0.001),(2) lack of cancer-related symptoms (145 vs 60 days, p<0.001), (3) presence of medical co-morbidities (111 vs 76 days, p=0.01), and (4) depression (127 vs 98 days, p=0.029). Substance abuse increased the interval from initial abnormal image to tissue diagnosis by 29 days (p=0.032) but did not affect the interval from image to treatment. The mean interval between diagnosis and initiation of treatment was 19 days longer in blacks vs. non-blacks (55 vs 36 days, p=0.0118) although the overall time from abnormal image to diagnosis and to treatment was not statistically different. In a multivariate model adjusting for stage, histology, reason for initial imaging, and presence of a primary care provider, implementation of a CCCP resulted in a mean reduction of 25 days in the time between the first abnormal image and initiation of cancer treatment (126 to 101 days, p=0.0154). The percent of patients diagnosed at stages I and II increased from 32% to 48% (p=0.0065) after the implementation of a CCCP. Conclusions: A centralized, multidisciplinary, hospital-based CCCP can improve timeliness of NSCLC care, and may also help ensure that incidental, early stage lung cancers are treated.