2009 Jun - Timelines in the Diagnosis and Management of Bronchogenic Carcinoma – A Retrospective Cohort Study in a Regional Hospital
Dr Liong Ting Joyce, Department of Medicine & Geriatrics, United Christian Hospital
Introduction
Bronchogenic carcinoma is the leading cause of cancer death in many countries. Besides, it is associated with poor prognosis despite the advances in investigation and treatment modalities. Staging is one of the factors that affect the prognosis of patients with bronchogenic carcinoma, which may be influenced by delays in patient presentation or unduly prolonged periods of workup. Shortening these delays may potentially improve the staging, and hence the survival. Studies in the West estimated that the delay from first symptom to treatment ranged from 3 to 7 months. Since little is known about the timelines in diagnosing and managing bronchogenic carcinoma and how it might affect the survival in our locality, we conducted a study to investigate the timelines of diagnosis, treatment and its effect on the survival of bronchogenic carcinoma in Hong Kong.
Method
This is a retrospective cohort study. All case notes of patients diagnosed to have bronchogenic carcinoma in United Christian Hospital in 2002 were reviewed.
Results
We identified 134 patients with histological or cytologically confirmed bronchogenic carcinoma in 2002. The mean age at diagnosis was 68.8 ± 10.4 years, the predominant histology was adenocarcinoma (46.3%) and non-small cell lung cancer (NSCLC) (29.9%). Male gender (p = 0.015), and incidental finding of abnormal CXR (p = 0.001) were independently associated with shorter time from first symptom to first consultation. First attendance at the emergency department was associated with shorter time from first visit to any clinician to diagnosis (p <0.001). The median survival and 5-year survivals of histologically confirmed bronchogenic carcinoma were 169 days and 3.3% respectively. More advanced staging (p < 0.001) and a shorter time from first seen by specialist to diagnosis (p = 0.045) were independently associated with an earlier death. Female, non-smoking patients with adenocarcinoma had better survival, after adjustment for age, Charlson’s score, median time from first seen by specialist to diagnosis and staging (p = 0.03).
Conclusion
Our study described the individual timelines of management of bronchogenic carcinoma. Poorer survival was seen in patients with more advanced staging, and a shorter delay from first consultation to diagnosis. However, that could have reflected the possible fact that patients with more advanced disease and more severe symptoms received more timely care.
