Al Achkar Morhaf, Zigman Suchsland Monica, Walter Fiona M, Neal Richard D, Goulart Bernardo H L, Thompson Matthew J
Department of Family Medicine, University of Washington, Seattle, Washington, USA
Department of Family Medicine, University of Washington, Seattle, Washington, USA.
BMJ Open. 2021 Apr 22;11(4):e045056. doi: 10.1136/bmjopen-2020-045056.
Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.
We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.
Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.
40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the 'patient interval', individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the 'primary care interval', doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the 'secondary care interval', obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.
Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.
大多数肺癌患者在晚期才被诊断出来。然而，口服靶向治疗的出现改善了许多肺癌患者的预后。
我们旨在了解携带致癌基因突变的晚期肺癌患者的诊断经历。
对患有致癌性改变的晚期或转移性非小细胞肺癌患者进行了定性访谈。患者从美国的在线支持小组中招募。访谈通过远程或面对面的方式进行。分析采用迭代归纳和演绎的过程。主题被映射到治疗途径模型。
纳入了40名患者（12名男性和28名女性），中位年龄为48岁。我们确定了九个不同的主题。在“患者间隔期”，个体开始关注症状，但往往将其归因于其他原因。持续或更严重的症状促使他们寻求医疗护理。在“初级保健间隔期”，医生最初治疗的是癌症以外的疾病。发现影像学异常是诊断途径中的一个转折点。偶尔，症状的严重程度促使患者寻求急诊护理。在“二级保健间隔期”，获取组织样本对于确诊至关重要。获得肿瘤学护理的延迟有时会导致患者痛苦。进行基因检测对于指导患者接受靶向治疗至关重要。
患者经历了多种不同的诊断途径。一些患者察觉到了延迟、低效和缺乏协调，这可能令人痛苦。将肺癌的诊断阶段提前以优化靶向治疗的效果需要在早期检测方面做出共同努力。
