title: Timeliness of lung cancer diagnosis and treatment in a rapid outpatient diagnostic program with combined 18FDG-PET and contrast enhanced CT scanning.
abstract: BACKGROUND
  Delays in the diagnosis of lung cancer are under debate and may affect outcome. The objectives of this study were to compare various delays in a rapid outpatient diagnostic program (RODP) for suspected lung cancer patients with those described in literature and with guideline recommendations, to investigate the effects of referral route and symptoms on delays, and to establish whether delays were related to disease stage and outcome.
  
  
  METHODS
  A retrospective chart study was conducted of all patients with suspected lung cancer, referred to the RODP of our tertiary care university clinic between 1999 and 2009. Patient characteristics, tumor stage and different delays were analyzed.
  
  
  RESULTS
  Medical charts of 565 patients were retrieved. 290 patients (51.3%) were diagnosed with lung cancer, 48 (8.5%) with another type of malignancy, and in 111 patients (19.6%) the radiological anomaly was diagnosed as non-malignant. In 112 (19.8%) no immediate definite diagnosis was obtained, however in 82 of these cases (73.2%) the proposed follow-up strategy confirmed a benign outcome. The median first line delay was 54 days, IQR (interquartile range) 20-104 days, median patient delay 19 days (IQR 4-52 days), median referral delay was 7 days (IQR 5-9 days), median diagnostic delay 2 days (IQR 1-19 days). In 87% a diagnosis was obtained within 3 weeks after visiting a chest physician and 52.5% started curative therapy within 2 weeks after diagnosis. Patients presenting with hemoptysis had shorter first line delays. The RODP care was generally far more timely compared to literature and published guidelines, except for both referral and palliative therapeutic delay. No specific delay was significantly related to disease stage or survival.
  
  
  CONCLUSIONS
  An RODP results in a timely diagnosis well within guideline recommendations. Patient and first line delay account for most of total patient delay. Within the limitations of this retrospective study, we found no association with disease stage or survival.
authors.affiliation: Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. pbrocken@gmail.com
authors.forename: Pepijn
authors.initials: P
authors.lastname: Brocken
authors.forename: Berni A B
authors.initials: BA
authors.lastname: Kiers
authors.forename: Monika G
authors.initials: MG
authors.lastname: Looijen-Salamon
authors.forename: P N Richard
authors.initials: PN
authors.lastname: Dekhuijzen
authors.forename: Chantal
authors.initials: C
authors.lastname: Smits-van der Graaf
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Peters-Bax
authors.forename: Lioe-Fee
authors.initials: LF
authors.lastname: de Geus-Oei
authors.forename: Henricus F M
authors.initials: HF
authors.lastname: van der Heijden
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D001999:Bronchoscopy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006287:Health Planning Guidelines; D006571:Heterocyclic Compounds; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D009367:Neoplasm Staging; D009426:Netherlands; D009942:Organometallic Compounds; D049268:Positron-Emission Tomography; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; D019788:Fluorodeoxyglucose F18; C435266:contrast agent P792