title: Timing in initiating lung cancer treatment after bronchoscopy in France: Study from medico-administrative database.
abstract: BACKGROUND
  Time-to-treatment of cancer is becoming a serious political and social issue. A greater understanding of the timeframes involved in cancer care is needed to reduce inequalities in access to care caused by delays.
  
  
  OBJECTIVE
  To describe time delays in each phase of lung cancer treatment after bronchoscopy.
  
  
  METHODS
  Using the international classification of diseases and medical procedures codes, from national hospital discharge database we selected patients newly diagnosed for Lung cancer in 2009-2010 who had undergone treatment.
  
  
  RESULTS
  We included 14,596 patients. Median times from bronchoscopy to 1) neo-adjuvant chemotherapy and to surgery in patients with surgical pathway were 34d (Q25=22; Q75=47) and 44d (Q25=26; Q75=82), respectively, 2) chemotherapy and to radiotherapy in patients with non-surgical pathway, were 33d (Q25=22; Q75=49) and 88d (Q25=46; Q75=162) respectively, 3) first treatment irrespective of pathway and treatment combination was 34d (Q25=22; Q75=50). Time to first treatment was significantly higher with age and with the status of the first care center. It was longer in most northern regions and in overseas districts and shorter in southern and eastern regions of the country.
  
  
  CONCLUSIONS
  To our knowledge, this is the first study based on medico-administrative database describing time to first treatment after bronchoscopy in patients suffering from lung cancer in France. It could inform decision-making on guidelines on times to access lung cancer treatment.
authors.affiliation: Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12 rue du val d'Osne, 94414 Saint-Maurice, France. Electronic address: y.kudjawu@invs.sante.fr.
authors.forename: Yao Cyril
authors.initials: YC
authors.lastname: Kudjawu
authors.affiliation: Assistance publique des hôpitaux de Paris, Unité d'épidémiologie et de recherche clinique, INSERM CIC1418, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.affiliation: Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12 rue du val d'Osne, 94414 Saint-Maurice, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Decool
authors.affiliation: Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12 rue du val d'Osne, 94414 Saint-Maurice, France.
authors.forename: Florence
authors.initials: F
authors.lastname: de Maria
authors.affiliation: Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12 rue du val d'Osne, 94414 Saint-Maurice, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Beltzer
authors.affiliation: Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12 rue du val d'Osne, 94414 Saint-Maurice, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Grémy
authors.affiliation: Assistance publique des hôpitaux de Paris, Service de Pneumologie-soins intensifs, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France.
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.affiliation: Institut de veille sanitaire, Direction scientifique et de la qualité, 12 rue du val d'Osne, 94414 Saint-Maurice, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eilstein
mesh_terms: D000368:Aged; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061665:Time-to-Treatment
keywords: Bronchoscopy; Hospital-discharge database; Lung neoplasm; Time-to-treatment