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Timeliness of Care in Veterans with Non-Small-Cell Lung Cancer

¹VA Palo Alto Health Care System, Palo Alto, CA ²Stanford School of Medicine, Stanford, CA

gould{at}stanford.edu

Abstract

BackgroundTimeliness is an important dimension of quality of care for patients with lung cancer.

MethodsWe reviewed records of consecutive patients diagnosed with non-small cell lung cancer (NSCLC) between 1/1/02 and 12/31/03 at VA Palo Alto Health Care System. We used multivariable statistical methods to identify independent predictors of timely care, and examined the effect of timeliness on survival.

ResultsWe identified 129 veterans with NSCLC (mean age 67 years, 98% men, 83% white), most with adenocarcinoma (51%) or squamous cell carcinoma (30%). A minority (18%) presented with a solitary pulmonary nodule (SPN). Median time from initial suspicion of cancer to treatment was 84 days (interquartile range 38 to 153 days). Independent predictors of treatment within 84 days included hospitalization within 7 days (OR 8.2, 95% CI 2.9 to 23), tumor size > 3.0 cm (OR 4.8, 95% CI 1.8 to 12.4), presence of additional chest radiographic abnormalities (OR 3.0, 95% CI 1.1 to 8.5), and presence of one or more symptoms suggesting metastasis (OR 2.6, 95% CI 1.1 to 6.2). More timely care was not associated with better survival (adjusted hazard ratio 1.5, 95% CI 0.9 to 2.5). However, in patients with SPN, there was a trend toward better survival when time to treatment was < 84 days.

ConclusionsTime to treatment for patients with NSCLC was often longer than recommended. Patients with larger tumors, symptoms and other chest radiographic abnormalities receive more timely care. In patients with malignant SPN, survival may be better when treatment is initiated promptly.

Key Words: Carcinoma • Non-small-cell Lung • Coin Lesion • Pulmonary • Quality of Health Care • Time Factors • Veterans