Time to treatment for lung cancer patients at an urban safety net institution.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 26-26
Author(s):  
Kalyani Narra ◽  
Yan Lu ◽  
Bassam Ghabach ◽  
Rohit P. Ojha
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Stage Iv ◽  
Safety Net ◽  
Self Report ◽  
Optimal Time ◽  
Time To Treatment ◽  
Lung Cancer Patients ◽  
Urban Safety

26 Background: Lung cancers are rapidly fatal, but no guidelines currently exist in the US for the optimal time between symptomatic presentation and treatment. A recent study from multiple institutions estimated a median of 52 days from symptomatic presentation to treatment, but this estimate was based on patient self-report and the study under-represented settings that provide care to patients with socioeconomic barriers to care that could affect time to treatment. Therefore, we aimed to assess time to treatment for lung cancer patients at an urban safety-net institution. Methods: We used institutional registry data from the JPS Center for Cancer Care (Fort Worth, TX), an accredited Comprehensive Community Cancer Program. Eligible patients were aged ≥18 years and had a pathological diagnosis of lung cancer between January 1, 2018 and December 31, 2018. We estimated the median overall and stage-specific time from abnormal imaging (chest X-ray or CT scan) to initiation of treatment, which were documented in medical records. Results: Our study population comprised 75 lung cancer patients. The majority of patients who received treatment ( n=46) were aged 55–64 years (54%), female (52%), and racial/ethnic minorities (54%). The overall median time to treatment was 81 days (interquartile range [IQR]=48–111) which varied by stage: stage I=108 (IQR=92–140), stage II=123 (IQR=111–134), stage III=85 (IQR=45, 102), stage IV=59 (IQR=39–72). In particular, the median time from ordering chemotherapy to start was 22 days (IQR= 13–30). Conclusions: Time to treatment for lung cancer patients at our institution is substantially longer than reported in the literature, which may partially reflect the patient population but warrants interventions (e.g. enhanced care coordination) to reduce this interval. Nevertheless, without an optimal time to treatment that is associated with improved outcomes among lung cancer patients, we and other institutions lack a meaningful benchmark.

Reducing delays to lung cancer treatment through systematic consult scheduling: A multidisciplinary quality improvement initiative at a safety-net hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18640-e18640
Author(s):  
Yue Lin ◽  
Muhammad M. Qureshi ◽  
Umit Tapan ◽  
Kei Suzuki ◽  
Ehab Billatos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Median Time ◽  
Safety Net ◽  
Appointment Scheduling ◽  
Treatment Delays ◽  
Cause Analysis ◽  
Lung Cancer Patients ◽  
Root Cause ◽  
Safety Net Hospital

e18640 Background: Delays in diagnosis and treatment have been identified as practice gaps in lung cancer management. At our large safety-net hospital, 2016-2018 data provided by the Commission on Cancer (CoC) indicated that 58-66% of lung cancer patients began treatment > 30 days after their diagnosis, compared to a median of 30 days for CoC-accredited hospitals. A quality improvement (QI) project was performed to identify causes for treatment delays, and to implement changes to reduce the median time from diagnosis to treatment to < 30 days. Methods: Root cause analysis was performed on a cohort of lung cancer patients identified and abstracted by the CoC Registry with diagnosis in October 2018-September 2019, to provide more recent data on treatment delays and to identify actionable interventions. Subsequently, a multidisciplinary QI initiative through Thoracic Surgery, Hematology Oncology, and Radiation Oncology was implemented using the Plan-Do-Study-Act (PDSA) tool. The initiative was tracked for 6 months starting in August 2020, with time from referral to consult and time from diagnosis to treatment calculated via chart review. Results: For the root cause analysis, 36 patients were identified. Eleven cases were excluded as they did not receive treatment at our institution. For the remaining 25 patients, the median time from referral to consult across all three oncology specialties was 13 days. The most common barriers to initiating treatment were appointment scheduling delays (37.5%), patient factors including synchronous malignancies or insurance, geographic or cultural barriers (31.3%), and multiple factors including appointment scheduling delays (25%). Median time from diagnosis to treatment was 31 days, with 36% (N = 9) starting treatment in < 30 days. While appointment scheduling delays included both work-up (imaging, procedures) and consults as well as follow-ups, multidisciplinary discussions identified time from referral to consult as the most actionable QI initiative. With support from Patient Navigation, the three oncology specialties jointly implemented a system whereby suspected or confirmed new lung cancer patients were scheduled for consult ideally in < 7 days, and no more than 14 days from the referral date. Of 28 new lung cancer patients who started treatment after the QI intervention, median time from referral to consult decreased to 7 days. Median time from diagnosis to treatment decreased to 26.5 days, with 53.6% (N = 15) of patients starting treatment in < 30 days. Conclusions: By decreasing time from referral to consult, this multidisciplinary QI intervention facilitated earlier initiation of treatment for lung cancer patients. Similar actions to decrease other scheduling delays and mitigate the impact of social determinants of health could further promote improvements in timely patient care.

scholarly journals Torque Teno Virus load in lung cancer patients correlates with age but not with tumor stage

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252304
Author(s):  
Dirk Stefani ◽  
Balazs Hegedues ◽  
Stephane Collaud ◽  
Mohamed Zaatar ◽  
Till Ploenes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Early Stage ◽  
Stage Iv ◽  
Tumor Stage ◽  
Plasma Dna ◽  
Early Stage Lung Cancer ◽  
Lung Cancer Patients ◽  
Stage Iv Lung Cancer ◽  
Stage Lung Cancer

Background Torque teno virus (TTV) is a ubiquitous non-pathogenic virus, which is suppressed in immunological healthy individuals but replicates in immune compromised patients. Thus, TTV load is a suitable biomarker for monitoring the immunosuppression also in lung transplant recipients. Since little is known about the changes of TTV load in lung cancer patients, we analyzed TTV plasma DNA levels in lung cancer patients and its perioperative changes after lung cancer surgery. Material and methods Patients with lung cancer and non-malignant nodules as control group were included prospectively. TTV DNA levels were measured by quantiative PCR using DNA isolated from patients plasma and correlated with routine circulating biomarkers and clinicopathological variables. Results 47 patients (early stage lung cancer n = 30, stage IV lung cancer n = 10, non-malignant nodules n = 7) were included. TTV DNA levels were not detected in seven patients (15%). There was no significant difference between the stage IV cases and the preoperative TTV plasma DNA levels in patients with early stage lung cancer or non-malignant nodules (p = 0.627). While gender, tumor stage and tumor histology showed no correlation with TTV load patients below 65 years of age had a significantly lower TTV load then older patients (p = 0.022). Regarding routine blood based biomarkers, LDH activity was significantly higher in patients with stage IV lung cancer (p = 0.043), however, TTV load showed no correlation with LDH activity, albumin, hemoglobin, CRP or WBC. Comparing the preoperative, postoperative and discharge day TTV load, no unequivocal pattern in the kinetics were. Conclusion Our study suggest that lung cancer has no stage dependent impact on TTV plasma DNA levels and confirms that elderly patients have a significantly higher TTV load. Furthermore, we found no uniform perioperative changes during early stage lung cancer resection on plasma TTV DNA levels.

The Potential Clinical Significance of the Serum Iron and Ferritin Status in Lung Cancer Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 189-195
Author(s):  
Fei Fei Guo ◽  
◽  
Shi Jia Cheng ◽  
Yi Ning Liu ◽  
Jiu Wei Cui ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Serum Ferritin Level ◽  
Ferritin Level ◽  
Stage Iv ◽  
Iron Level ◽  
Serum Iron Level ◽  
Lung Cancer Patients

Background An increasing number of studies have shown that iron, one of the indispensable trace elements in the human body, is closely related to the occurrence and development of cancer. However, few studies have clearly demonstrated the role of the iron levels in lung cancer patients, or the potential effects of inflammation on iron levels. Methods The clinical data for lung cancer patients and non-lung cancer participants were retrospectively analyzed. The serum iron and ferritin levels were measured and compared using a rank-sum test. The correlation between the serum iron/ferritin and C-reactive protein (CRP) was analyzed by rank correlation. The cut-off values for continuous variables were obtained by the receiver operating characteristic curve (ROC) method. An analysis of potential prognostic factors in lung cancer patients was conducted by univariate and multivariate survival analyses. Results The serum iron levels in patients with extensive small-cell lung cancer (SCLC) were lower than those with limited-stage SCLC, and the levels of serum ferritin and CRP in those with extensive SCLC were higher than those with limited-stage SCLC. Similarly, the serum iron levels in patients with stage IV non-small cell lung cancer (NSCLC) were lower than those of patients with stage Ⅰ-Ⅲ disease, and the levels of serum ferritin and CRP in those with stage IV NSCLC were higher than those in stages Ⅰ-Ⅲ. The serum iron level was negatively correlated with the level of CRP, while the serum ferritin level was positively correlated with CRP. The stage of lung cancer, but not the serum iron/ ferritin level, was an independent prognostic factor in lung cancer patients. Conclusions The serum iron and ferritin levels are associated with the staging of lung cancer. The later stages of lung cancer are associated with a lower serum iron level, a higher serum ferritin level, and a higher CRP level. Inflammation may play an important role in regulating the serum iron and ferritin levels in lung cancer patients.

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