Elsevier

Lung Cancer

Volume 112, October 2017, Pages 156-164
Lung Cancer

Review
Timeliness of access to lung cancer diagnosis and treatment: A scoping literature review

https://doi.org/10.1016/j.lungcan.2017.08.011Get rights and content

Highlights

  • Significant variation exists in how access to lung cancer care is reported.

  • Many patients are waiting longer than recommended for diagnosis and treatment.

  • Standardization of meaningful wait intervals across the care continuum is needed.

  • Common metrics can improve ability to assess quality, interventions, and outcomes.

Abstract

The Institute of Medicine recently called for increased understanding of and commitment to timely care. Lung cancer can be difficult to diagnose, resulting in delays that may adversely affect survival; rapid diagnosis and treatment therefore is critical for enabling improved patient outcomes. This scoping review provides an update on timeliness of lung cancer care over the past decade. We searched PubMed for English-language articles published from 2007 to 2016 that report wait time intervals related to diagnosis and treatment of lung cancer. Two authors independently reviewed titles and abstracts for inclusion. Abstracted data included sample size, patient population, study type, dates of study, wait times, and information on disparities, survival, costs, healthcare utilization, and interventions. The final review included 65 studies from 21 different countries. A total of 96 unique variations of wait intervals were reported (e.g., time to diagnosis from first pulmonologist visit, imaging, or initial evaluation), making comparisons across studies difficult. The most common interval was diagnosis to treatment initiation, with reported medians ranging from 6 to 45 days. Fourteen articles reported information on survival, 14 on healthcare utilization, 18 on disparities, and 14 on interventions; results varied by study. Significant variation exists in how access to care time delays are reported. Many patients across different facilities and countries appear to be facing substantial waits to receive lung cancer diagnosis and care. Further research, using common wait-interval metrics, is needed to evaluate and improve timeliness of lung cancer diagnosis and treatment.

Introduction

The Institute of Medicine (IOM) released a report in June 2015 calling for greater attention to timeliness of care, which is the least studied and least understood of the IOM’s six fundamental properties of high quality healthcare [1], [2]. The IOM report also proposed an idealized benchmark that new patients should wait no longer than ten days for new specialty care visits, and no more than one day for urgent specialty care such as oncology.

Lung cancer can be difficult to diagnose and is the leading cause of cancer deaths worldwide [3]. Timely detection, diagnosis, and subsequent treatment for lung cancer is critical to patient outcomes and well-being. Delays in any part of the process, from initial evaluation and referral, to definitive diagnosis, treatment, follow-up, and survivorship care, may lead to adverse patient outcomes. In an effort to reduce such delays, experts have established consensus-based standards for maximum acceptable waiting times for referral, diagnosis, and treatment specifically for lung cancer. In 1998, the British Thoracic Society (BTS) formulated a set of recommendations under the BTS Standards of Care Committee and in 2000 the RAND Corporation published target intervals for lung cancer access to care [4], [5]. In 2011, the United Kingdom’s (UK) National Institute for Health and Care Excellence (NICE) published revised guidelines on lung cancer care diagnosis and treatment [6]. They recommended that patients with suspected lung cancer receive a specialist appointment within two weeks and that x-rays be performed within two weeks for patients meeting certain clinical criteria for lung cancer risk. More recently, UK’s National Optimal Lung Cancer Pathway proposes patient assessment pathways to be used in reference with BTS and NICE guidelines to help achieve maximum waiting times of 14 days for diagnosis and 28 days for treatment [7]. Unfortunately, these standards are not always upheld, and significant delays in lung cancer care persist [8].

To begin to assess the evidence about these delays and to formulate potential questions and analytic approaches for further research, we conducted a scoping review of the literature. The primary objectives of this review were to examine how wait times experienced by patients with lung cancer have been measured and to summarize existing evidence on delays in timely care. Reviews of the timeliness of lung cancer care were published in 2009 by Olsson et al. [8] and in 2014 by Vinas et al. [9], examining lung cancer care waiting times and the relationship between waiting times and outcomes such as patient survival. We focused our review on literature published since June 2007 and expanded information collected to include costs, healthcare utilization, and disparities.

Section snippets

Methods

We conducted a scoping review of the medical literature using methods outlined by Arskey and O’Malley and Levac et al. [10]. Using Medical Subject Heading (MeSH) terms and keywords, we searched PubMed for English-language articles on timeliness of lung cancer diagnosis and treatment published from June 2007 to July 2016; the time period following a previously published literature review on timeliness of lung cancer care [8]. The full search term for the current review are provided in the online

Results

The final search resulted in 901 articles, of which 641 were excluded through title review and 173 were excluded through abstract review, leaving 86 articles for full review (Fig. 1). An additional 21 articles were excluded upon full review. Of the 65 articles included in the review, studies took place in 21 different countries with nearly half (48%) conducted in the United States (US), United Kingdom, or Canada (Table S1, online Supplement). Sample sizes ranged from 8 to 56,624 patients with a

Discussion

In this scoping review, we identified 65 articles published between 2007 and 2016 measuring timeliness of lung cancer diagnosis and treatment in 21 countries. A 2009 systematic review on timeliness of lung cancer care by Olsson et al. summarized wait time intervals reported in 49 studies published between 1995 and 2007 [8]. While 24 of those articles were from the UK or Ireland with only 5 from the US, our updated literature review included 15 US articles and 7 from the UK, suggesting a

Conclusions

This scoping literature review highlighted substantial heterogeneity in reporting on timeliness of access to lung cancer care. Measurement standardization of meaningful wait intervals across this care continuum is needed for improved ability to assess and compare quality, interventions, and patient outcomes, especially since many patients still face longer than recommended wait times for diagnosis and treatment of lung cancer.

Potential conflict of interest disclosures

Ms. Jacobsen, Ms. Silverstein, and Dr. Quinn have nothing to disclose. Dr. Benneyan reports grants from the National Science Foundation during the conduct of the study. Dr. Thomas reports he has served as an advisor and provided paid educational/promotional activities for Genentech, Bristol-Myers, Janssen and Celgene. Dr. Han and Mr. Waterson report grants from Bristol-Myers Squibb Foundation (BMSF) during the conduct of the study.

Role of the funding source

This work was supported partially by the National Science Foundation (NSF) [grant number IIP-1034990]. The findings and conclusions in this article are solely those of the authors; NSF was not involved in the design, writing, or publishing of this paper.

Acknowledgement

We thank Hande Musdal, PhD, for her technical assistance with developing figures.

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