Global Journal on Quality and Safety in Healthcare (Aug 2019)

Wait Times for Diagnosis and Treatment of Lung Cancer: Experience of the Medical Oncology Department of Hassan II University Hospital of Fez

  • Zineb Benbrahim,
  • Othmane Zouiten,
  • Kawthar Messoudi,
  • Mariam Atassi,
  • Lamiaa Amaadour,
  • Karima Oualla,
  • Samia Arifi,
  • Samira ElFakir,
  • Nawfel Mellas

DOI
https://doi.org/10.4103/JQSH.JQSH_8_19

Abstract

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Background: Lung cancer is a public health problem in Morocco. Multiple clinical practice guidelines recommend rapid evaluation of patients with suspected lung cancer. It is uncertain whether delays in diagnosis and management are correlated with outcomes. The objective of this study was to evaluate if these delays have any negative effect on outcomes. Methods: This retrospective study included 140 patients diagnosed with non-small cell lung cancer (NSCLC). It was conducted at the Medical Oncology Department of Fez from January 2016 to December 2017. We have studied many wait times and considered that: wait time to consult (WTC) is the delay from the first symptom to initial consultation, wait time to diagnosis (WTD) is the delay from initial consultation to diagnosis, wait time to referral (WTR) is the delay from diagnosis to referral to the oncologist, and wait time to treatment (WTT) is the time from referral to treatment initiation. Our analysis used Kaplan–Meier method to estimate the overall survival (OS). To compare the OS between wait time categories, we used the logrank test. Results: The median age was 59.46 years. The sex ratio was 6 men for 1 woman. The most common histological subtype was adenocarcinoma (58.6% of cases). Eighty-two percent of patients were diagnosed at stage IV. The median WTC was 240 days (range, 15–280 days), WTD was 45 days (13–65), WTR was 54 days (13–63), and WTT was 32 days (12–40). The only factor that was associated with a long WTD was long distance (> 60 km) to the hospital (p = 0.05). We found that short WTC, WTD, and WTR had better OS: 12 versus 3 months (p < 0.0001), 12 versus 4 months (p < 0.0001), and 14 versus 5 months (p < 0.0001), respectively. We found no difference in OS between short and long WTT. Conclusion: In our study, patients with lung cancer experience significant delays from development of symptoms to first treatment initiation. We found a clear association between survival and short delays from initial symptoms to consultation, from consultation to diagnosis, and from diagnosis to referral to the department of oncology.

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