Abstract
The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012–2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273–691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11–240), specialist consultation to diagnosis 72 days (IQR 13–456), and from diagnosis to treatment initiation 7 days (IQR 0–36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.
Funder
Gordon and Betty Moore Foundation
Cancer Research UK
Cancer Surveillance System of the Fred Hutchinson Cancer Research Center
Fred Hutchinson Cancer Research Center
Reference53 articles.
1. American Cancer Society (2022, May 11). Lung Cancer Survival Rates. Available online: https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html.
2. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement;Ann. Intern. Med.,2014
3. Lung cancer screening;Natl. Compr. Cancer Netw.,2012
4. Lung Cancer Screening Rates During the COVID-19 Pandemic;Chest,2021
5. A Proposal to Improve the Early Diagnosis of Symptomatic Cancers in the United States;Cancer Prev. Res.,2020
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献