Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: A population-based study.

OBJECTIVES Elderly carry a disproportionate burden of lung cancer in the US. Therefore, its important to ensure that these patients receive quality cancer care. Timeliness of care is an important dimension of cancer care quality but its impact on prognosis remains to be explored. This study evaluates the variations in guideline-concordant timely lung cancer care and prognosis among elderly in the US. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2002-2007), we identified elderly patients with lung cancer (n=48,850) and determined time to diagnosis and treatment. We categorized patients by receipt of timely care using guidelines from the British Thoracic Society and the RAND Corporation. Hierarchical generalized logistic model was constructed to identify variables associated with receipt of timely care. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the three-year survival. Multivariable Cox proportional hazards model was constructed to estimate lung cancer mortality risk associated with receipt of delayed care. RESULTS Time to diagnosis and treatment varied significantly among the elderly. However, majority of them (77.5%) received guideline-concordant timely lung cancer care. The likelihood of receiving timely care significantly decreased with NSCLC disease, early stage diagnosis, increasing age, non-white race, higher comorbidity score, and lower income. Paradoxically, survival outcomes were significantly worse among patients receiving timely care. Adjusted lung cancer mortality risk was also significantly lower among patients receiving delayed care, relative to those receiving timely care (Hazard ratio (HR)=0.68, 95% Confidence interval (CI)=(0.66-0.71); p ≤ 0.05). CONCLUSION This study highlights the critical need to address disparities in receipt of guideline-concordant timely lung cancer care among elderly. Although timely care was not associated with better prognosis in this study, any delays in diagnosis and treatment should be avoided, as it may increase the risk of disease progression and psychological stress in patients. Furthermore, given that lung cancer diagnostic and management services are covered under the Medicare program, observed delays in care among Medicare beneficiaries is also a cause for concern.

[1]  Makoto Tanaka,et al.  Outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor. , 2003, Lung cancer.

[2]  R. Deyo,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. , 1992, Journal of clinical epidemiology.

[3]  P. Arbak,et al.  Effect of Symptom-To-Treatment Interval on Prognosis in Lung Cancer , 2007 .

[4]  M. Hendryx,et al.  Guideline-concordant lung cancer care and associated health outcomes among elderly patients in the United States. , 2015, Journal of geriatric oncology.

[5]  R. Dewar,et al.  Radiotherapy wait times for patients with a diagnosis of invasive cancer, 1992-2000. , 2004, Clinical and investigative medicine. Medecine clinique et experimentale.

[6]  G. Colice,et al.  Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. , 2003, Chest.

[7]  D. Ferrigno,et al.  Lung cancer: clinical presentation and specialist referral time , 2004, European Respiratory Journal.

[8]  M. Gould,et al.  Timeliness of care in veterans with non-small cell lung cancer. , 2008, Chest.

[9]  H. Satoh,et al.  Time from finding abnormality on mass-screening to final diagnosis of lung cancer. , 2003, Oncology reports.

[10]  J. Jollis,et al.  Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. , 1993, Journal of clinical epidemiology.

[11]  S. Yong,et al.  Timeliness of care in patients with lung cancer: a systematic review , 2009, Thorax.

[12]  E. McGlynn,et al.  Quality of Care for Oncologic Conditions and HIV , 2000 .

[13]  H. Hansen,et al.  Lung cancer. , 1990, Cancer chemotherapy and biological response modifiers.

[14]  C. Stafford,et al.  Population characterization, histological evaluation, and timeliness of care of surgical nonsmall cell lung cancer patients in a military academic medical center. , 2012, Military medicine.

[15]  Yang Xie,et al.  Lung Cancer Diagnostic and Treatment Intervals in the United States: A Health Care Disparity? , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[16]  G. Hillerdal,et al.  Effect of delays on prognosis in patients with non-small cell lung cancer. , 2004, Thorax.

[17]  B. Leese,et al.  Stage, survival and delays in lung, colorectal, prostate and ovarian cancer: comparison between diagnostic routes. , 2007, The British journal of general practice : the journal of the Royal College of General Practitioners.

[18]  M. Gould,et al.  Hospital characteristics associated with timeliness of care in veterans with lung cancer. , 2009, American journal of respiratory and critical care medicine.

[19]  Deborah Schrag,et al.  Overview of the SEER-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population , 2002, Medical care.

[20]  M. Gould,et al.  Timeliness of care in patients with lung cancer: a systematic review , 2009, Thorax.

[21]  L. J. Wei,et al.  The Robust Inference for the Cox Proportional Hazards Model , 1989 .

[22]  M. Muers.  BTS recommendations to respiratory physicians for organising the care of patients with lung cancer , 1998, Thorax.

[23]  H. Comber,et al.  Delays in treatment in the cancer services: impact on cancer stage and survival. , 2005, Irish medical journal.

[24]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[25]  W. Mackillop,et al.  Waiting times for cancer surgery in Ontario: 1984-2000. , 2006, Clinical oncology (Royal College of Radiologists (Great Britain)).

[26]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[27]  M. Dransfield,et al.  Improving the lung cancer resection rate in the US Department of Veterans Affairs Health System. , 2006, Clinical lung cancer.

[28]  J. Little,et al.  Impact of deprivation and rural residence on treatment of colorectal and lung cancer , 2002, British Journal of Cancer.

[29]  G. Bepler,et al.  Lung cancer. Practice organization. , 2003, Chest.

[30]  L. Kessler,et al.  Potential for Cancer Related Health Services Research Using a Linked Medicare‐Tumor Registry Database , 1993, Medical care.

[31]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[32]  T. Whelan,et al.  Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993-2000. , 2005, Canadian journal of surgery. Journal canadien de chirurgie.