Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Centro Hospitalar do Porto, Porto, Portugal.
PLoS One. 2021 Jun 4;16(6):e0252529. doi: 10.1371/journal.pone.0252529. eCollection 2021.
We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal.
Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0).
Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals.
Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.
本研究旨在明确葡萄牙医生对肺癌诊断、分期和治疗的局限性和延误的看法。
邀请葡萄牙医生参与电子调查（2020 年 2 月至 4 月）。采用描述性统计分析，分类变量以绝对数和相对数表示，非正态分布的连续变量以中位数和四分位间距（IQR）表示。采用 Pearson 卡方检验评估分类变量之间的关系。采用 Mann-Whitney 检验比较分类和连续变量（Stata v.15.0）。
61 名医生参与了研究（45 名肺病专家，16 名肿瘤专家），其中 26 名医生仅负责肺癌患者。大多数专家在里斯本的公立医院（90.16%）工作（36.07%）。在 2019 年的最后一个学期，应答者平均进行了 85 例（IQR 55-140）肺癌诊断。导致转诊至专科较慢的因素包括服务之间沟通不畅（60.0%）和患者经济/文化水平低（44.26%）。获得国家药品管理局的批准是延迟治疗开始的主要原因之一（75.41%）。从患者入院到治疗开始的累积延迟时间为 42-61 天。专家认为，大约有 11.05 天（IQR 9.61-12.50）的时间可以优化诊断时间。大多数医生（88.52%）在因体力状况恶化（65.57%）或肿瘤负荷高（52.46%）导致生物标志物结果出现之前开始治疗。专门协助肺癌病例的医生报告称，在获得生物标志物分析授权方面的延误较少（p = 0.023）。公立医院的专业人员报告说，手术（p = 0.001）、放疗（p = 0.004）和免疫治疗（p = 0.003）的等待时间更长。
医生认为，通过多学科团队和医院管理的进一步努力，可以减少肺癌诊断各个阶段的延误。
