Symptom severity influences treatment delays in lung cancer patients

Non-small cell lung cancer (NSCLC) patients with advanced disease receive quicker diagnosis and treatment despite their poorer prognosis than do patients with earlier stage disease, according to a report in the January issue of Thorax.

“It is difficult to prove with this kind of study the benefit of prompt treatment among patients with early-stage cancer,” Dr. Gunnar Myrdal from Uppsala University Hospital, Uppsala, Sweden told Reuters Health. “It seems that we use the most effort to treat those with advanced disease promptly, and those with suspect early disease have to wait much longer.” Dr. Myrdal and colleagues examined the relation between delays and survival in 466 NSCLC patients who received curative or palliative treatment with surgery, chemotherapy, or radiation in the years 1995 through 1999. Patients with stage IV NSCLC experienced a significantly shorter delay between first symptoms and treatment. Only 9% of patients with early stage disease were treated within 3 months of the onset of symptoms, compared with 27% of patients with stage IIIB disease and 43% of patients with stage IV disease.The time from first hospital visit to first treatment (hospital delay) was also significantly shorter among patients with more advanced disease, the results indicate. Overall 3-year survival was only 11% for patients with symptom to treatment delays under 3 months, the researchers note, compared with 35% for patients with delays of more than 6 months. Similarly, patients experiencing the shortest hospital delays had the poorest prognosis. In risk factor analyses, there was a significant interaction between tumor stage and both symptom to treatment delay and hospital delay. The 190 patients who received no treatment experienced the shortest delay between first hospital visit and the decision not to treat, the report indicates, and their 3-year survival was only 5%.”These results,” Dr. Nyrdal concluded, “underline that the current health care system takes great care of those with serious symptoms having a fatal disease — advanced cancer.” However, “every effort must be done to find patients with early stage cancer and to treat them without delay.(Source: Thorax 2004;59:45-49: Reuters Health: January 19, 2004: Oncolink)