title: The impact of timeliness of care on survival in non-small cell lung cancer patients.
abstract: BACKGROUND
  It is uncertain whether timeliness improves clinical outcomes in lung cancer patients. The goal of the study was to analyse the influence of patient's and doctor's delays on survival of unselected population of NSCLC patients.
  
  
  METHODS
  From 1995 to 1998, 8705 squamous cell lung cancer patient's and 1881 adenocarcinoma patient's were registered in Pulmonary Outpatients Clinics in all parts of Poland and subsequently in National Tuberculosis and Lung Diseases Research Institute Register (NTLDRIR).
  
  
  RESULTS
  The median time from first symptom(s) to the beginning of a treatment was 92 days (mean -138.5 days).The median waiting time between first symptom(s) and first visit to a doctor's was 30 days (mean 57 days) and from first visit to a doctor's to referral to a chest physician - was 17 days (mean 41days). Diagnosis of the NSCLC was established in a mean time of 71 days (median 40 days), but chest physician diagnosed patients in a mean time of 51days (median 28 days). The multivariate analysis revealed that ECOG performance status (PS) 2 (HR = 1.4) and 3+4 (HR = 2.23), clinical stage of the disease II (HR = 1.32), III (HR = 1.41), and IV (HR = 1.82) were independent negative predictors of survival. Non-surgically treated patients had worse prognosis than patients treated surgically (HR = 3.03). Lack of patient's delay had a significant positive impact on survival (HR = 0.88), particularly for patients in PS 0+1 (HR = 0.9) and 3+4 (HR = 0.9). Lack of doctor's delay was a negative predictive factor of survival (HR = 1.14). It was observed particularly in patients in performance status 2 (HR = 1.28).
  
  
  CONCLUSIONS
  The patient's delay and lack of doctor's delay had a negative impact on survival of NSCLC patients.
authors.affiliation: National Tuberculosis and Lung Diseases Research Institute, Plocka 26 St., 01–138 Warsaw, Poland. e.radzikowska@igichp.edu.pl
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Radzikowska
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Roszkowski-Śliż
authors.forename: Piotr
authors.initials: P
authors.lastname: Głaz
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000628:therapy*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D016019:Survival Analysis