Delays in lung cancer diagnosis and treatment: real-life assessment in a tertiary care center

Abstract

Introduction: Clinical guidelines recommend rapid evaluation of patients with suspected lung cancer. There are few data concerning delays in the diagnostic process of lung cancer in Portugal and adherence to recommendations. The aim of this work is to review and analyze the different phases in the process of diagnosis, staging, therapeutic decision and treatment within a pulmonology department. Methods: Retrospective, single -center cohort study, with identification and analysis of the different stages of the pathway taken by patients with suspected lung cancer. The study contemplates the flow design and characterization related to waiting times. Descriptive statistical analysis of waiting times in each step and total waiting times and comparison with available guidelines. Results: 77 patients included, predominantly male (72.7%), mean age of 66. Mean time from admission to start of treatment was 68 days (±55.2). Most patients underwent bronchoscopy (71.4%), which was conclusive in 54.6%; 39 patients (50.6%) needed a second exam and 14 (18.2%) a third one. Mean time from multidisciplinary decision to treatment was 14 days (±25.6). There were great differences between modalities: 6 days (±8) to chemotherapy, 5 days (±2) to radiation therapy and 63 days (±33) to surgery. Adherence to guidelines varied between 36.4% and 50.6% concerning total time and between 44.2% and 58.4% for time from diagnosis to treatment. Conclusion: Total time of the process exceeded main guidelines in 6 to 26 days; however, there was considerable heterogeneity and results do not differ greatly from other published data. Proposing an optimized workflow may shorten critical stages and improve global performance, allowing for improvements in doctor and patient’s expectations.