Influence of Delays in Diagnosis and Treatment on Survival in Small Cell Lung Cancer Patients
- 30 May 2013
- book chapter
- other
- Published by Springer Science and Business Media LLC in Advances in experimental medicine and biology
- Vol. 788, 355-362
- https://doi.org/10.1007/978-94-007-6627-3_48
Abstract
The purpose of this study was to evaluate the influence on survival of delays in the diagnosis and treatment in an unselected population of small cell lung (SCLC) patients. Demographic and disease data of 3,479 SCLC patients were registered in the National Tuberculosis and Lung Diseases Research Institute in Warsaw, Poland during 1995–1998. In 50 % of patients, treatment started within 78 days from the appearance of first symptom(s). The median delay was 30 days (mean 47 days) and the median referral delay to a specialist was 19 days (mean 36 days). Half of SCLC patients were diagnosed during 34 days (mean 55 days). The mean time elapse from the diagnosis to the onset of therapy was 30 days (median 6 days). The multivariate analysis revealed that male gender-HR (hazard ratio = 1.2), ECOG Performance Status of 2 (HR = 1.5) and 3 + 4 (HR = 2.4), and clinical stage III (HR = 1.3) and IV (HR = 1.9) of the disease were independent negative predictors of survival. The patients treated with surgery and combined modality treatment had a better prognosis than those treated with chemoradiotherapy (HR = 1.6), chemotherapy (HR = 2.5), symptomatically (HR = 4.0), or those who refused therapy (HR = 3.9). The delay in the diagnosis and treatment had no effect on survival. Interestingly, patients who were diagnosed faster (below 42 days) actually had a worse prognosis than those diagnosed later. We conclude that a prolonged workup of SCLC patients and an extended time for treatment onset have a positive influence on survival, which may likely have to do with the determination of disease stage and more targeted treatment.Keywords
This publication has 20 references indexed in Scilit:
- Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic ScreeningNew England Journal of Medicine, 2011
- Lung Cancer Diagnosis from Proteomic Analysis of Preinvasive LesionsCancer Research, 2011
- Wait Times for Cancer Surgery in the United StatesAnnals of Surgery, 2011
- Predictors of long‐term survival of lung cancer patients in a Norwegian communityThe Clinical Respiratory Journal, 2010
- Timeliness of care in patients with lung cancer: a systematic reviewThorax, 2009
- Prognostic factors for limited-stage small cell lung cancer: A study of 284 patientsLung Cancer, 2009
- Lung cancer: clinical presentation and specialist referral timeEuropean Respiratory Journal, 2004
- Lung cancer mortality patterns in selected Central, Eastern and Southern European countriesInternational Journal of Cancer, 2004
- Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancerPublished by Oxford University Press (OUP) ,2002