Specialist Referral Time in Diagnosis and Surgical Treatment of Non-small Cell Lung Cancer at a Tertiary Military Medical Center

Abstract

PURPOSE: The purpose of this study is to describe the characteristics of patient's with nonsmall cell lung cancer(NSCLC) who underwent curative surgery, to determine specialist time to diagnose and treat NSCLC in comparison to the British Thoracic Society (BTS) guidelines, and to determine what medical comorbidities delay time to surgery. METHOD(S): We conducted a retrospective record review of NSCLC patients who underwent curative surgery from 2004 to 2009 at Naval Medical Center San Diego. Data collected include demographics, medical comorbidities, pathologic type and stage of NSCLC, and PET-CT results. Outcome data include pulmonary and cardiothoracic surgery referral time, time to PET-CT, and time to thoracotomy. RESULT(S): Of the 84 patients, median age was 65 and BMI was 26. The majority of patients used tobacco (71%). More nonsmokers were women (22%, p = 0.009) and Asian/pacific islander women were overrepresented (p = 0.002). The predominant histology was adenocarcinoma (72%) and the majority was PET-CT nonavid (57%). Median time for pulmonologist evaluation was 8 days (7-12, 95%CI), median time for PET-CT was 13 days (11-15, 95%CI), median time for cardiothoracic surgery evaluation to thoracotomy was 25 days (20-36, 95%CI), and median time from pulmonologist evaluation to thoracotomy was 59 days (49-71, 95%CI). Chronic obstructive lung disease (COPD) and vascular disease significantly delayed time to thoracotomy (p = 0.01 to 0.03). CONCLUSION(S): Nonsmoking women and Asian/pacific islander women with early stage NSCLC are overrepresented in this group. BTS guidelines for timeliness in diagnosis and treatment NSCLC are very difficult to attain particularly in patients with COPD and vascular disease. CLINICAL IMPLICATIONS: Multidisciplinary cooperation and institutional measures can expedite lung cancer evaluations and treatment. More emphasis should be placed on timeliness of evaluation in patients with COPD and vascular disease. Further research is warranted for identifying subgroups of women with NSCLC and whether screening measures have benefit.