Timeliness of care in veterans with non-small cell lung cancer.
BACKGROUND
Timeliness is an important dimension of quality of care for patients with lung cancer.


METHODS
We reviewed the records of consecutive patients in whom non-small cell lung cancer (NSCLC) had been diagnosed between January 1, 2002, and December 31, 2003, at the Veterans Affairs Palo Alto Health Care System. We used multivariable statistical methods to identify independent predictors of timely care and examined the effect of timeliness on survival.


RESULTS
We identified 129 veterans with NSCLC (mean age, 67 years; 98% men; 83% white), most of whom had adenocarcinoma (51%) or squamous cell carcinoma (30%). A minority of patients (18%) presented with a solitary pulmonary nodule (SPN). The median time from the initial suspicion of cancer to treatment was 84 days (interquartile range, 38 to 153 days). Independent predictors of treatment within 84 days included hospitalization within 7 days (odds ratio [OR], 8.2; 95% confidence interval [CI], 2.9 to 23), tumor size of > 3.0 cm (OR, 4.8; 95% CI, 1.8 to 12.4), the presence of additional chest radiographic abnormalities (OR, 3.0; 95% CI, 1.1 to 8.5), and the presence of one or more symptoms suggesting metastasis (OR, 2.6; 95% CI, 1.1 to 6.2). More timely care was not associated with better survival time (adjusted hazard ratio, 1.6; 95% CI, 1.3 to 1.9). However, in patients with SPNs, there was a trend toward better survival time when the time to treatment was < 84 days.


CONCLUSIONS
The time to treatment for patients with NSCLC was often longer than recommended. Patients with larger tumors, symptoms, and other chest radiographic abnormalities receive more timely care. In patients with malignant SPNs, survival may be better when treatment is initiated promptly.
Gould
Michael K
MK
Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (111P), Palo Alto, CA 94304, USA. gould@stanford.edu
Ghaus
Sharfun J
SJ
Olsson
Julie K
JK
Schultz
Ellen M
EM
D000368:Aged; D044963:Biopsy, Fine-Needle; D001999:Bronchoscopy; D002140:California / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008481:Mediastinoscopy; D009367:Neoplasm Staging / Q000379:methods; D016017:Odds Ratio; D011785:Quality Assurance, Health Care / Q000379:methods*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014728:Veterans