Background: Timeliness is an important dimension of quality of care for patients with lung cancer.
Methods: We reviewed the records of consecutive patients in whom non-small cell
lung cancer (NSCLC) had been diagnosed between January 1, 2002, and
December 31, 2003, at the Veterans Affairs Palo Alto Health Care
System. We used multivariable statistical methods to identify
independent predictors of timely care and examined the effect of
timeliness on survival.
Results: We identified 129 veterans with NSCLC (mean age, 67 years; 98% men; 83%
white), most of whom had adenocarcinoma (51%) or squamous cell
carcinoma (30%). A minority of patients (18%) presented with a solitary
pulmonary nodule (SPN). The median time from the initial suspicion of
cancer to treatment was 84 days (interquartile range, 38 to 153 days).
Independent predictors of treatment within 84 days included
hospitalization within 7 days (odds ratio [OR], 8.2; 95% confidence
interval [CI], 2.9 to 23), tumor size of > 3.0 cm (OR, 4.8; 95% CI,
1.8 to 12.4), the presence of additional chest radiographic
abnormalities (OR, 3.0; 95% CI, 1.1 to 8.5), and the presence of one or
more symptoms suggesting metastasis (OR, 2.6; 95% CI, 1.1 to 6.2). More
timely care was not associated with better survival time (adjusted
hazard ratio, 1.6; 95% CI, 1.3 to 1.9). However, in patients with SPNs,
there was a trend toward better survival time when the time to
treatment was < 84 days.
Conclusions: The time to treatment for patients with NSCLC was often longer than
recommended. Patients with larger tumors, symptoms, and other chest
radiographic abnormalities receive more timely care. In patients with
malignant SPNs, survival may be better when treatment is initiated