Time spans from first symptom to treatment in patients with lung cancer--the influence of symptoms and demographic characteristics.
BACKGROUND
Cancer stage at diagnosis is the most important prognostic factor for lung cancer (LC), but most patients are diagnosed with advanced disease with many and intense symptoms. This study explores relationships between LC patients' first symptoms, symptoms triggering health care system (HCS) contact, demographic/clinical characteristics, and time spans in the care trajectory from first symptom(s) to treatment start.


METHODS
Medical records were examined from all 314 patients diagnosed with primary LC in 2003 at a Department of Respiratory Medicine, in Stockholm Sweden. Descriptive analysis was used to examine symptoms and time spans in the care trajectory. Cox regression analysis was conducted to explore the influence of symptoms and demographic/clinical characteristics on the time spans.


RESULTS
Tumor-specific symptoms led to HCS visits to a greater extent than did systemic symptoms, despite reports of weight loss, fatigue and appetite loss as common first symptoms. Minor differences between women and men were found regarding specific symptoms. The study confirms that the time spans from first symptoms reported to treatment start are extensive, exceeding Swedish national recommendations. A lump/resistance, neurological symptoms, appetite loss, hemoptysis and non-thoracic related pain were associated with significantly shorter time spans in the care trajectory. People >74 years old risked longer time span from first HCS visit to treatment start.


CONCLUSIONS
This study indicates a need for a more efficient LC care trajectory. Elderly patients could be particularly vulnerable for longer time spans.
Lövgren
Malin
M
The Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, 141 83 Huddinge, Sweden. malin.lovgren@ki.se
Leveälahti
Helena
H
Tishelman
Carol
C
Runesdotter
Sara
S
Hamberg
Katarina
K
D000368:Aged; D000855:Anorexia / Q000209:etiology; D002637:Chest Pain / Q000209:etiology; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D042241:Early Diagnosis; D004522:Educational Status; D005221:Fatigue / Q000209:etiology; D005260:Female; D006469:Hemoptysis / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors