González J M, de Castro F J, Barrueco M, Cordovilla R, Fernández J L, Gómez F P, Moreno de Vega B, Ramos J, Serrano A R
Servicio de Neumología. Hospital Universitario de Salamanca. Salamanca. Spain.
Arch Bronconeumol. 2003 Oct;39(10):437-41. doi: 10.1016/s0300-2896(03)75425-8.
To study the clinical and demographic factors associated with delays in the diagnosis of lung cancer.
A 2-year prospective study of patients admitted to the respiratory medicine ward with a suspected diagnosis of lung cancer. We studied demographic factors, health care received, place of residence, and delays in carrying out diagnostic procedures. The following diagnostic time periods were defined: consultation (from first symptom to first medical visit), middle period (from first medical visit to hospital admission) and diagnostic (from hospital admission to histological diagnosis and clinical staging).
One hundred thirteen patients with a mean age of 65 years (range, 36-90), 103 men and 10 women, were studied. The most frequent symptoms leading to consultation were coughing (10.6%), hemoptysis (19.5%), chest pain (26.5%), and shortness of breath (9.7%). First visits were to a primary care physician for 72%, to the hospital emergency room for 22%, or to a pulmonologist for 6%. Forty-four percent of the patients visited the doctor 2 or 3 times. The mean SD, numbers of days for the different time periods were as follows: consultation, 30.3 60; diagnosis, 18.6 19; middle period 37.9 63. The mean total time from first symptom to diagnosis was 85.7 87 days. The middle period, the time in hospital until diagnosis, and the total time were shorter when patients were referred by the primary care physician to the emergency room or were directly admitted to the hospital (P<.001). Only 25.7% of the staged lung cancers were operable.
Delays in lung cancer diagnosis are long. The attitudes of primary care physicians and their relations with specialized care providers are crucial for reducing delays.
研究与肺癌诊断延迟相关的临床和人口统计学因素。
对呼吸内科病房收治的疑似肺癌患者进行为期2年的前瞻性研究。我们研究了人口统计学因素、接受的医疗保健、居住地点以及诊断程序实施中的延迟情况。定义了以下诊断时间段：会诊期（从出现首个症状到首次就医）、中期（从首次就医到入院）和诊断期（从入院到组织学诊断和临床分期）。
共研究了113例患者，平均年龄65岁（范围36 - 90岁），其中男性103例，女性10例。导致会诊的最常见症状为咳嗽（10.6%）、咯血（19.5%）、胸痛（26.5%）和气短（9.7%）。72%的患者首次就诊于初级保健医生，22%就诊于医院急诊室，6%就诊于肺科医生。44%的患者就诊2或3次。不同时间段的平均标准差天数如下：会诊期30.3±60天；诊断期18.6±19天；中期37.9±63天。从首个症状到诊断的平均总时间为85.7±87天。当初级保健医生将会诊患者转诊至急诊室或患者直接入院时，中期、住院至诊断的时间以及总时间均较短（P<0.001）。仅25.7%的分期肺癌患者可进行手术。
肺癌诊断延迟时间较长。初级保健医生的态度及其与专科护理提供者的关系对于减少延迟至关重要。
