Barriers to Timely Lung Cancer Care in Early Stage Non-Small Cell Lung Cancer and Impact on Patient Outcomes.
Barriers to Timely Lung Cancer Care in Early Stage Non-Small Cell Lung Cancer and Impact on Patient Outcomes.
复制标题
早期非小细胞肺癌及时治疗的障碍及其对患者治疗结果的影响。
DOI：
10.1016/j.cllc.2023.10.013
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发表时间：
2024
影响因子：
3.6
通讯作者：
Deng,JaneC
中科院分区：
文献类型：
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作者：
Pirzadeh,Mina;Lagina,Madeline;Wood,Cameron;Valley,Thomas;Ramnath,Nithya;Arenberg,Douglas;Deng,JaneC
背景早期肺癌的最佳治疗时间是不确定的。我们研究了退伍军人谁提出了早期非小细胞肺癌（NSCLC）的护理延迟的原因，以及是否检查时间与增加的upstaging或全因mortality.MethodsWe相关进行了回顾性分析退伍军人提到我们的设施与放射学I期或II期NSCLC之间2013年1月至2017年12月，随访至2021年10月。收集患者的人口统计学资料、肿瘤特征、护理时间间隔和延迟原因。指南一致性（GC）定义为异常图像14周内的治疗。进行多变量分析，以确定在护理，生存和upstaging.ResultsData从203退伍军人之间的关联延迟进行了分析。影像学异常至治疗的中位时间为17.7周（IQR 12.7-26.6）。只有33%的退伍军人接受了GC护理。最常见的患者相关延迟为：并发住院/合并症（23%）、未就诊（16%）和无法联系退伍军人（17%）。最常见的系统相关延迟：缺乏可用的调度（25%）。与提前预约相关的延迟：交通问题、预约协调请求和不可预见的预约变更。胃癌组和不一致组的肿瘤分期升高率无差异（P= 0.6）。GC护理不是死亡率的独立预测因素。事后，治疗8周内与较低的率upstaging（P= 0.05）。结论虽然GC护理不影响生存或早期NSCLC的upstaging，较短的时间框架可能是有益的。在护理方面存在着可以改变的延误，可以在机构一级加以解决，以提高护理的及时性。
BackgroundOptimal time to treatment for early-stage lung cancer is uncertain. We examined causes of delays in care for Veterans who presented with early-stage non–small cell lung cancer (NSCLC) and whether workup time was associated with increased upstaging or all-cause mortality.MethodsWe performed a retrospective analysis of Veterans referred to our facility with radiographic stage I or II NSCLC between January 2013 to December 2017, with follow-up through October 2021. Patient demographics, tumor characteristics, time intervals of care, and reasons for delays were collected. Guideline concordance (GC) was defined as treatment within 14 weeks of abnormal image. Multivariable analyses were performed to determine association between delays in care, survival, and upstaging.ResultsData from 203 Veterans were analyzed. Median time between abnormal imaging to treatment was 17.7 weeks (IQR 12.7-26.6). Only 33% of Veterans received GC care. Most common patient-related delays were: intercurrent hospitalization/comorbidity (23%), no-shows (16%) and inability to reach Veteran (17%). Most common system-related delay: lack of scheduling availability (25%). Delays associated with upstaging: transportation issues, request for coordination of appointments, and unforeseen appointment changes. Rates of upstaging did not differ between GC and discordant groups (P= .6). GC care was not an independent predictor of mortality. Post-hoc, treatment within 8 weeks was associated with lower rates of upstaging (P= .05).ConclusionAlthough GC care did not impact survival or upstaging for early-stage NSCLC, shorter timeframes may be beneficial. Modifiable delays in care exist which may be addressed at an institutional level to improve timeliness of care.