Delays in lung cancer diagnosis and treatment: real-life assessment in a tertiary care center

Introduction: Clinical guidelines recommend rapid evaluation of patients with suspected lung cancer. There are few data concerning delays in the diagnostic process of lung cancer in Portugal and adherence to recommendations. The aim of this work is to review and analyze the different phases in the process of diagnosis, staging, therapeutic decision and treatment within a pulmonology department. Methods: Retrospective, single -center cohort study, with identification and analysis of the different stages of the pathway taken by patients with suspected lung cancer. The study contemplates the flow design and characterization related to waiting times. Descriptive statistical analysis of waiting times in each step and total waiting times and comparison with available guidelines. Results: 77 patients included, predominantly male (72.7%), mean age of 66. Mean time from admission to start of treatment was 68 days (±55.2). Most patients underwent bronchoscopy (71.4%), which was conclusive in 54.6%; 39 patients (50.6%) needed a second exam and 14 (18.2%) a third one. Mean time from multidisciplinary decision to treatment was 14 days (±25.6). There were great differences between modalities: 6 days (±8) to chemotherapy, 5 days (±2) to radiation therapy and 63 days (±33) to surgery. Adherence to guidelines varied between 36.4% and 50.6% concerning total time and between 44.2% and 58.4% for time from diagnosis to treatment. Conclusion: Total time of the process exceeded main guidelines in 6 to 26 days; however, there was considerable heterogeneity and results do not differ greatly from other published data. Proposing an optimized workflow may shorten critical stages and improve global performance, allowing for improvements in doctor and patient’s expectations.

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Very elderly patients and lung cancer in a tertiary care center: a real life experience

Annals of Oncology ◽

10.1093/annonc/mdx426.035 ◽

2017 ◽

Vol 28 ◽

pp. vi64

Author(s):

A. Ponzetti ◽

C. Crsitiano ◽

E. Milanesi ◽

G. Ritorto ◽

S. Bustreo ◽

...

Keyword(s):

Lung Cancer ◽

Elderly Patients ◽

Life Experience ◽

Care Center ◽

Tertiary Care ◽

Real Life ◽

Tertiary Care Center ◽

Very Elderly

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Clinicopathological Profile of Patients with Lung Carcinoma in a Tertiary Care Center

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1718977 ◽

2020 ◽

Author(s):

M.T. Chandramouli ◽

Giridhar Belur Hosmane

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Lung Carcinoma ◽

Care Center ◽

Tertiary Care ◽

Smoking History ◽

Tertiary Care Center ◽

Cell Type ◽

Lung Cancer Patients ◽

Incidence And Mortality

Abstract Introduction Among malignant diseases, lung carcinoma is the most common cancer in men worldwide in terms of both incidence and mortality. Its increasing incidence in developing countries like India is an important public health problem. This work aimed to study the demographic, clinical, radiological, and histological features of patients with confirmed lung cancer. Materials and Methods A total of 50 patients with histologically confirmed lung cancer at a tertiary care center in India from August 2016 to September 2018 were studied and analyzed. Results Out of 50 diagnosed lung cancer patients, 86% were men and 14% women; 31 (62%) patients were aged more than 60 years. Majority were smokers (84%) and all were men. Cough (94%) was the most common presenting symptom followed by dyspnea (68%), chest pain (48%), and hemoptysis (38%). Of the 50 patients, 29 (58%) had soft tissue density mass lesion on radiograph. Squamous cell carcinoma (SCC) was the diagnosed histological cell type in 24 (48%) patients and adenocarcinoma in 21 (42%) patients. Distant metastasis was observed in 20 (40%) patients. Conclusion In this study, the most common histopathological cell type is SCC. Patients aged more than 50 years and smokers are at high risk of lung cancer. Patients with a smoking history and persistent respiratory symptoms should be promptly evaluated for lung malignancy.

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Clinicopathological profile of lung cancer at a tertiary care center

Indian Journal of Cancer ◽

10.4103/ijc.ijc_455_17 ◽

2018 ◽

Vol 55 (3) ◽

pp. 273

Author(s):

SatyaPalanki Dattatreya ◽

Rekha Bansal ◽

Mohana Vamsy ◽

Salil Vaniawala ◽

SS Nirni ◽

...

Keyword(s):

Lung Cancer ◽

Care Center ◽

Tertiary Care ◽

Tertiary Care Center ◽

Clinicopathological Profile

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CMET-18. IMPACT OF KRAS MUTATION STATUS ON THE EFFICACY OF IMMUNOTHERAPY IN LUNG CANCER BRAIN METASTASES

Neuro-Oncology ◽

10.1093/neuonc/noz175.219 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi55-vi55

Author(s):

Adam Lauko ◽

Assad Ali ◽

Soumya Sagar ◽

Addison Barnett ◽

Hong Li ◽

...

Keyword(s):

Lung Cancer ◽

Brain Metastasis ◽

Brain Metastases ◽

Checkpoint Inhibitors ◽

Care Center ◽

Tertiary Care ◽

Wild Type ◽

Chi Square ◽

Kras Mutations ◽

Mutational Status

Abstract BACKGROUND Immunotherapy is increasingly used in patients with non-small cell lung cancer brain metastases (NSCLCBM). KRAS mutations are associated with worse prognosis and there is no FDA approved targeted therapy. KRAS mutations are associated with increased expression of PD-L1. We evaluated the outcomes of NSCLCBM with KRAS mutations treated with immune checkpoint inhibitors (ICI). METHODS We reviewed 800 patients with NSCLCBM treated at our tertiary care center. 226 had known KRAS mutational status, 121 of which received immunotherapy. Overall survival (OS) was calculated from either the start of immunotherapy (when both groups received immunotherapy) or from the date of diagnosis of brain metastasis. Kaplan-Meier method and Cox Proportional hazard model were utilized to determine differences in OS and the Chi-square test was utilized to determine differences in PD-L1 expression. RESULTS In 109 patients where both KRAS and PD-L1 status were known, KRAS mutations had greater PD-L1 expression (80.1% vs 61.9% positive, p=0.04). There was no difference in OS between KRAS mutant vs KRAS wild-type patients treated with immunotherapy. Median survival from the start of immunotherapy was 15.6 vs 15.5 months respectively (p=0.7), after adjusting for age, KPS, lesion number and extra-cranial metastasis (HR = .91, p=.7). Patients with KRAS mutations treated with immunotherapy versus those who received chemotherapy had a 1-year OS from the diagnosis of brain metastasis of 60.9% vs 38.7% respectively (trending towards significance, p=0.05). KRAS wild-type patients treated with immunotherapy versus those who did not receive immunotherapy had a 1-year OS from the diagnosis of brain metastasis of 61.9% vs 62.5% (p=0.85), respectively. DISCUSSION KRAS mutations are associated with increased PD-L1 expression. Use of immunotherapy negates the poor outcomes seen traditionally in patients with NSCLCBM and KRAS mutations and it improves survival compared to use of chemotherapy. Our experience supports the use of immunotherapy in these patients.

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Salivary Gland FNA Diagnostics in a Real-Life Setting: One-Year-Experiences of the Implementation of the Milan System in a Tertiary Care Center

Cancers ◽

10.3390/cancers11101589 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1589 ◽

Cited By ~ 6

Author(s):

Erkka Tommola ◽

Satu Tommola ◽

Sinikka Porre ◽

Ivana Kholová

Keyword(s):

Salivary Gland ◽

Classification System ◽

Predictive Value ◽

Care Center ◽

Tertiary Care ◽

Diagnostic Category ◽

Real Life ◽

Benign Neoplasm ◽

Tertiary Care Center ◽

One Year

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was introduced in 2018 following other organ specific cytopathological reporting systems and it aimed at bringing a practical, evidence-based, user-friendly classification system with characterization and management algorithms. At the Department of Pathology, Fimlab Laboratories, Tampere, Finland all salivary fine needle aspirations (FNAs) have been given cytopathological diagnoses according to the MSRSGC since January 2018. Analyses of a one-year-period (January 2018–December 2018) consisted of 183 salivary FNA samples from 138 patients with correlation to histopathology in 90 cases with surgical follow-up. The MSRSGC performance in patient based analysis was as follows: accuracy was 90.9%, sensitivity was 61.5%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89.4%, respectively. Risks of malignancy (ROMs) in MSRSGC categories were: 0.0% (0/15) in non-diagnostic category, 100.0% (1/1) in non-neoplastic category biased by only one falsely-negative lymphoma case, 14.3% (1/7) in atypia of undetermined significance category, 0.0% (0/28) in benign neoplasm category, 27.3% (3/11) in neoplasm of uncertain malignant potential category, and 100% for both suspicious for malignancy (4/4) and malignancy (4/4) categories, respectively. The MSRSGC has been proven as a reliable classification system in salivary gland FNA routine diagnostics in a tertiary care center.

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P1-095: Virological responses & liver functions in patients with HCV related cirrhosis after treatment with directly acting antivirals (DAAs), a real life experience from a tertiary care center in India

Journal of Viral Hepatitis ◽

10.1111/jvh.69_12923 ◽

2018 ◽

Vol 25 ◽

pp. 72-73

Keyword(s):

Life Experience ◽

Care Center ◽

Tertiary Care ◽

Real Life ◽

Tertiary Care Center ◽

Liver Functions

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Epidemiology of primary and secondary headaches in a Brazilian tertiary-care center

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2006000100009 ◽

2006 ◽

Vol 64 (1) ◽

pp. 41-44 ◽

Cited By ~ 23

Author(s):

André Carvalho Felício ◽

Denis Bernardi Bichuetti ◽

William Adolfo Celso dos Santos ◽

Clecio de Oliveira Godeiro Junior ◽

Luis Fabiano Marin ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Population Sample ◽

Tension Type Headache ◽

Hypnic Headache ◽

Secondary Headaches ◽

The Mean ◽

Headache Clinic ◽

Type Headache ◽

Few Data

OBJECTIVE: To analyze the demographic features of the population sample, the time of headache complaint until first consultation and the diagnosis of primary and secondary headaches. METHOD: 3328 patients were analyzed retrospectively and divided according to gender, age, race, school instruction, onset of headache until first consultation and diagnosis(ICHD-II, 2004). RESULTS: Sex ratio (Female/Male) was 4:1, and the mean age was 40.7±15 years, without statistical differences between sexes. Approximately 65% of the patients were white and 55% had less than eight years of school instruction. Headache complaint until first consultation ranged from 1 to 5 years in 32.99% patients. The most prevalent diagnosis were migraine (37.98%), tension-type headache-TTH (22.65%) and cluster headache (2.73%). CONCLUSION: There are few data on epidemiological features of headache clinic populations, mainly in developing countries. According to the literature, migraine was more frequent than TTH. It is noteworthy the low school instruction of this sample and time patient spent to seek for specialized attention. Hypnic headache syndrome was seen with an unusual frequency.

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