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Review
. 2022 Apr 29;29(5):3187-3199.
doi: 10.3390/curroncol29050259.

Wait Times and Survival in Lung Cancer Patients across the Province of Quebec, Canada

Marie-Hélène Denault  1   2 , Catherine Labbé  1 , Carolle St-Pierre  1 , Brigitte Fournier  1 , Andréanne Gagné  1 , Claudia Morillon  1 , Philippe Joubert  1 , Serge Simard  1 , Simon Martel  1
Affiliations
Review

Wait Times and Survival in Lung Cancer Patients across the Province of Quebec, Canada

Marie-Hélène Denault et al. Curr Oncol. .

Abstract

Lung cancer is the leading cause of cancer death worldwide, with a five-year survival of 22% in Canada. Guidelines recommend rapid evaluation of patients with suspected lung cancer, but the impact on survival remains unclear. We reviewed medical records of all patients with newly diagnosed lung cancer in four hospital networks across the province of Quebec, Canada, between 1 February and 30 April 2017. Patients were followed for 3 years. Wait times for diagnosis and treatment were collected, and survival analysis using a Cox regression model was conducted. We included 1309 patients, of whom 39% had stage IV non-small cell lung cancer (NSCLC). Median wait times were, in general, significantly shorter in patients with stage III-IV NSCLC or SCLC. Surgery was associated with delays compared to other types of treatments. Median survival was 12.9 (11.1-15.7) months. The multivariate survival model included age, female sex, performance status, histology and stage, treatment, and the time interval between diagnosis and treatment. Longer wait times had a slightly protective to neutral effect on survival, but this was not significant in the stage I-II NSCLC subgroup. Wait times for the diagnosis and treatment of lung cancer were generally within targets. The shorter wait times observed for advanced NSCLC and SCLC might indicate a tendency for clinicians to act quicker on sicker patients. This study did not demonstrate the detrimental effect of longer wait times on survival.

Keywords: delays; non-small cell lung cancer; overall survival; small cell lung cancer; timeliness; wait times.

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Conflict of interest statement

Catherine Labbé has received honoraria from AstraZeneca, Brystol-Myers Squibb, Merck, Pfizer, and Roche. She has also received payment for expert testimony from Roche and Pfizer. She has also been on advisory boards for Amgen, Pfizer, Roche, AstraZeneca, Brystol-Myers Squibb, Sanofi Genzyme, Jazz Pharmaceuticals, LEO Pharma, and Merck. Philippe Joubert has received grants from AstraZeneca, Biomark Diagnostic Signature, and Imagia. He has also received honoraria from AstraZeneca. Marie-Hélène Denault, Carolle Saint-Pierre, Brigitte Fournier, Andréanne Gagné, Claudia Morillon, Serge Simard, and Simon Martel do not have any interests to declare.

Figures

Figure 1
Figure 1
Diagnosis and treatment time intervals. * Defined as the date of the pathology result. A = 1st abnormal imaging to 1st treatment; B = 1st appointment with specialist to 1st treatment. C = diagnosis to 1st treatment (including surgery, definitive radiation, definitive chemoradiation, and systemic treatment); D = pathology result to biomarkers result. A fifth interval, radiation referral to radiation, is not displayed on this figure.
Figure 2
Figure 2
Flow chart of patient selection.
Figure 3
Figure 3
Overall survival for the whole cohort (n = 1172). Data cutoff date was 13 May 2020. Overall survival was defined as the time from diagnosis to death.
See this image and copyright information in PMC

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Grants and funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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