Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Lung Cancer. 2012 Mar;75(3):336-41. doi: 10.1016/j.lungcan.2011.08.017. Epub 2011 Sep 22.
Delays in the diagnosis of lung cancer are under debate and may affect outcome. The objectives of this study were to compare various delays in a rapid outpatient diagnostic program (RODP) for suspected lung cancer patients with those described in literature and with guideline recommendations, to investigate the effects of referral route and symptoms on delays, and to establish whether delays were related to disease stage and outcome.
A retrospective chart study was conducted of all patients with suspected lung cancer, referred to the RODP of our tertiary care university clinic between 1999 and 2009. Patient characteristics, tumor stage and different delays were analyzed.
Medical charts of 565 patients were retrieved. 290 patients (51.3%) were diagnosed with lung cancer, 48 (8.5%) with another type of malignancy, and in 111 patients (19.6%) the radiological anomaly was diagnosed as non-malignant. In 112 (19.8%) no immediate definite diagnosis was obtained, however in 82 of these cases (73.2%) the proposed follow-up strategy confirmed a benign outcome. The median first line delay was 54 days, IQR (interquartile range) 20-104 days, median patient delay 19 days (IQR 4-52 days), median referral delay was 7 days (IQR 5-9 days), median diagnostic delay 2 days (IQR 1-19 days). In 87% a diagnosis was obtained within 3 weeks after visiting a chest physician and 52.5% started curative therapy within 2 weeks after diagnosis. Patients presenting with hemoptysis had shorter first line delays. The RODP care was generally far more timely compared to literature and published guidelines, except for both referral and palliative therapeutic delay. No specific delay was significantly related to disease stage or survival.
An RODP results in a timely diagnosis well within guideline recommendations. Patient and first line delay account for most of total patient delay. Within the limitations of this retrospective study, we found no association with disease stage or survival.
肺癌诊断的延迟仍存在争议，并可能影响预后。本研究的目的是比较疑似肺癌患者快速门诊诊断计划（RODP）中的各种延迟与文献和指南建议中的描述，调查转诊途径和症状对延迟的影响，并确定延迟是否与疾病分期和结果相关。
对 1999 年至 2009 年间我院三级保健大学诊所疑似肺癌患者的所有 RODP 患者进行了回顾性图表研究。分析患者特征、肿瘤分期和不同的延迟。
共检索到 565 份病历。290 例（51.3%）患者被诊断为肺癌，48 例（8.5%）患者被诊断为另一种恶性肿瘤，111 例（19.6%）患者的放射学异常被诊断为非恶性。112 例（19.8%）患者未立即获得明确诊断，但在这 82 例（73.2%）患者中，提出的随访策略证实了良性结果。一线延迟中位数为 54 天，IQR（四分位距）20-104 天，患者延迟中位数为 19 天，IQR（四分位距）4-52 天，转诊延迟中位数为 7 天，IQR（四分位距）5-9 天，诊断延迟中位数为 2 天，IQR（四分位距）1-19 天。87%的患者在就诊胸部医生后 3 周内获得诊断，52.5%的患者在诊断后 2 周内开始接受治愈性治疗。咯血患者的一线延迟较短。RODP 护理在很大程度上比文献和已发布的指南更及时，除了转诊和姑息性治疗延迟。没有特定的延迟与疾病分期或生存显著相关。
RODP 可及时诊断，符合指南建议。患者和一线延迟占总患者延迟的大部分。在本回顾性研究的限制范围内，我们未发现与疾病分期或生存相关的关联。
