From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi).
Can J Surg. 2021 Mar 26;64(2):E218-E227. doi: 10.1503/cjs.013319.
Timeliness can have a substantial effect on treatment outcomes, prognosis and quality of life for patients with lung cancer. We sought to evaluate changes in wait times for patients with non-small cell lung carcinoma (NSCLC) and to identify bottlenecks in cancer care.
We included patients who received treatment with curative intent or palliative treatment for NSCLC, diagnosed through mediastinal staging by a thoracic surgeon. Data were collected from 3 cohorts over 3 time periods: before the regionalization of lung cancer care (2005-2007, C1), immediately postregionalization (2011-2013, C2) and 5 years after regionalization (2016-2017, C3). Total wait time and delays along treatment pathways were compared across cohorts using multivariate Cox proportionality models.
Our total sample size was 299 patients. Overall, there was no significant difference in total wait time among the 3 cohorts. However, wait time from symptom onset to first physician visit significantly increased in C3 compared with C2 (hazard ratio [HR] 0.41, p < 0.01) and C1 (HR 0.43, p < 0.01). Time from first physician visit to computed tomography (CT) scan significantly decreased in C3 compared with C2 (HR 1.54, p < 0.01). Time from abnormal CT scan to first surgeon visit also significantly decreased in C2 (HR 1.43, p < 0.01) and C3 (HR 4.47, p < 0.01) compared with C1, and between C3 and C2 (HR 2.67, p < 0.01). In contrast, time from first surgeon visit to completion of staging significantly increased in C2 (HR 0.36, p < 0.01) and C3 (HR 0.24, p < 0.01) compared with C1, as well as between C3 and C2 (HR 0.60, p < 0.01). Time to first treatment after completion of staging was significantly shorter for C3 than C1 (HR 1.58, p < 0.01).
Trends toward a reduction in wait time are evident 5 years after the regionalization of lung cancer care, primarily led by shorter wait times for CT scans and thoracic surgeon consults. However, wait times can further be reduced by addressing delays in staging completion and patient and provider education to identify the early signs of NSCLC.
肺癌患者的治疗结果、预后和生活质量可能会受到及时性的显著影响。我们旨在评估非小细胞肺癌（NSCLC）患者的等待时间变化，并确定癌症治疗中的瓶颈。
我们纳入了通过胸外科医生纵隔分期诊断为 NSCLC 并接受根治性或姑息性治疗的患者。数据来自三个队列在三个时间点收集：肺癌治疗区域化之前（2005-2007 年，C1）、区域化后即刻（2011-2013 年，C2）和区域化后 5 年（2016-2017 年，C3）。使用多变量 Cox 比例风险模型比较了三个队列之间的总等待时间和治疗途径中的延迟。
我们的总样本量为 299 名患者。总体而言，三个队列之间的总等待时间没有显著差异。然而，C3 组从症状出现到首次就诊的等待时间明显长于 C2 组（风险比 [HR] 0.41，p<0.01）和 C1 组（HR 0.43，p<0.01）。与 C2 组（HR 1.54，p<0.01）和 C1 组（HR 1.43，p<0.01）相比，C3 组从首次就诊到 CT 扫描的时间明显缩短。与 C1 组相比，C2 组（HR 1.43，p<0.01）和 C3 组（HR 4.47，p<0.01）中，从异常 CT 扫描到首次外科医生就诊的时间也明显缩短，而 C3 组与 C2 组之间（HR 2.67，p<0.01）也是如此。相比之下，与 C1 组相比，C2 组（HR 0.36，p<0.01）和 C3 组（HR 0.24，p<0.01）中，从首次外科医生就诊到完成分期的时间明显延长，而且 C3 组与 C2 组之间（HR 0.60，p<0.01）也是如此。与 C1 组相比，C3 组完成分期后的首次治疗时间明显缩短（HR 1.58，p<0.01）。
在肺癌治疗区域化后 5 年，等待时间呈缩短趋势，这主要是由于 CT 扫描和胸外科医生咨询的等待时间缩短所致。然而，通过解决分期完成的延迟和患者和提供者的教育以识别 NSCLC 的早期迹象，可以进一步缩短等待时间。
