Survival after community diagnosis of early-stage non-small cell lung cancer.
BACKGROUND
"Rush to surgery" among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer.


METHODS
Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable.


RESULTS
The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.05), stage IIB (HR, 2.17; 95% CI, 1.12-4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05-12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21-16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00-1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance.


CONCLUSIONS
Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.
Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: nkanarek@jhsph.edu.
Norma F
NF
Kanarek
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
Craig M
CM
Hooker
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
Luckson
L
Mathieu
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
Hua-Ling
HL
Tsai
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
Charles M
CM
Rudin
Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Md.
James G
JG
Herman
Department of Surgery, Johns Hopkins University School of Medicine, Bunting Blaustein Cancer Research Building, Baltimore, Md.
Malcolm V
MV
Brock
D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D015982:Bias; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D061665:Time-to-Treatment; D047368:Tumor Burden
Lung; Lung cancer biology; Lung cancer surgery; Quality care management; Statistics; Survival analysis