title: Wait times in diagnostic evaluation and treatment for patients with stage III non-small cell lung cancer in British Columbia.
abstract: OBJECTIVE
  Non-small cell lung cancer (NSCLC) is associated with poor prognosis. Although this is mostly due to the aggressive natural history of the disease, the effect of treatment delays on patient outcomes is unclear. This study examines various time intervals in the diagnostic evaluation, staging, and treatment of patients with unresectable stage III NSCLC.
  
  
  METHODS
  A case-control study of patients with stage III NSCLC in British Columbia was carried out. One hundred nineteen patients treated radically with chemoradiotherapy were matched with 238 patients treated palliatively. Multivariate analysis was used to compare treatment delays and prognostic factors in the 2 groups.
  
  
  RESULTS
  Compared with radically treated cases, patients treated palliatively had shorter median times from first symptom to first abnormal test (32 vs. 58 d) and from first symptom to pathologically confirmed diagnosis (67 vs. 90 d). More radically treated patients (61% vs. 50%) were first assessed by a thoracic surgeon, whereas more palliatively treated patients (73% vs. 50%) were initially assessed by a respirologist. The median time from diagnosis to referral to a cancer center was similar between the 2 groups, but palliative cases were 5 times more likely to have a delay of >55 days between diagnosis and referral. This delay was observed in 24% of palliatively treated and 7% of radically treated cases.
  
  
  CONCLUSIONS
  The wait time from first symptom to referral to a regional cancer center in British Columbia for stage III NSCLC was approximately 3 to 4 months. Efforts to reduce wait times are warranted to reduce patient distress and possibly disease progression.
authors.affiliation: Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, Victoria, BC, Canada. ewai@bccancer.bc.ca
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Wai
authors.forename: Murray
authors.initials: M
authors.lastname: Mackinnon
authors.forename: Ross
authors.initials: R
authors.lastname: Hooker
authors.forename: Patrizia
authors.initials: P
authors.lastname: Moccia
authors.forename: Kristi R
authors.initials: KR
authors.lastname: Perry
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D001955:British Columbia; D018287:Carcinoma, Large Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D059248:Chemoradiotherapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D012017:Referral and Consultation; D013997:Time Factors