Relationship between delayed diagnosis and the degree of invasion and survival in lung cancer

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Abstract

Background and objective

The aim of this study is to evaluate the relationship between the interval from first symptom to diagnosis (SDI) and the degree of invasion and survival in lung cancer.

Methods

Three hundred seventy-eight patients with lung cancer were included. SDI was defined as the time calculated from the cytohistologic confirmation of the diagnosis of cancer and the first symptoms noted by the patient and attributed to cancer by the physician. The degree of invasion was determined by TNM classification.

Results

The median SDI was 2.1 months, and did not correlate with stage. Survival decreased progressively according to TNM classification. Adjusting for age, sex, SDI and TNM, survival was influenced by age (RR = 1.02) and by staging [Stage (Ib) RR = 1.3; stage (IIIa) RR = 2.6; stage (IIIb) RR = 4.06; stage (IV) RR = 7.5]. SDI was not found to affect survival (RR = 1.01; 95% CI: 0.94–1.08). In the small cell group, SDI also failed to modify survival.

Conclusions

The results of this study indicate that SDI has no effect on the stage or survival of patients with lung cancer.

Introduction

Patients with lung cancer are subject to different delays in the diagnosis of the disease and in receiving surgical treatment [1], [2], [3], [4], and several different reasons have been identified as their cause [3], [5]. Delayed diagnosis may, in turn, lead to medicolegal problems [6]. In asymptomatic populations, three controlled clinical trials have evaluated the effectiveness of screening with chest radiography and cytology on the reduction of lung cancer mortality [7], [8], [9]: after 5 to 11 years of follow-up, no significant benefit was shown in the reduction of mortality amongst patients with this type of cancer. At present, no scientific organization recommends routine screening for the general public or smokers, including chest radiography or cytology [10], [11], [12], [13], [14], [15], [16].

Studies also have been carried out into the impact that symptom to diagnosis interval (SDI) in cancer diagnosis may have on the stage of the tumor at the time of surgery or the diagnosis [1], [17], [18], [19], as well as the impact of delayed diagnosis on survival [18], [19]. Different studies have indicated a relationship between delayed diagnosis and the degree of invasion of the cancer. Some authors have either suggested [20], [21] or demonstrated [17] that a shorter SDI progressively decreases the degree of invasion and increases the survival rate. Others, however, have asserted that there is not necessarily any relationship between SDI, the extent of invasion and mortality [1], [19], [22], [23], [24], and some have indicated that in general terms, SDI does not affect the degree of invasion but does modify the survival rate [18].

As Porta et al. [19] discussed, the concept of the “early detection” of cancer may be veiling two different phenomena: the limited extension of a tumor at the time of diagnosis, or a short period of time between the clinical onset of the disease and its diagnosis.

The main objective of this study was to evaluate the relationship between delayed diagnosis, the degree of invasion and survival in lung cancer.

Section snippets

Methods and materials

During the period from January 1, 1997, to December 31, 1998, 378 patients were diagnosed as having lung cancer at the Complejo Hospitalario Juan Canalejo in A Coruña (Spain). This medical complex covers the population of the A Coruña health district, totaling some 500,000 people. All the cases included in the study had cytohistologic confirmation, and the variables studied in all of the patients were obtained from their clinical histories. Cases without anatomopathologic confirmation were

Results

The 378 patients were followed up for a mean period of 12.4 months and a median of 6.5 months. As 85.4% of the patients died during follow-up, 14.6% of the cases were censored. The censored data are independent of SDI and sex.

The patients had a mean age of 65.7±11.4, with a median of 66 years and a range of 31 to 90 years; 95.5% of the patients were male, and were significantly older than the female patients, 66.1 vs. 56.6 years (P = .011).

At the time of their diagnosis, 35.5% of the patients

Discussion

The results of this study show that SDI has no effect on the stage of patients with lung cancer. This result is maintained after adjusting for age and sex. These findings are consistent with those published by Robinson [18] and Porta [19]. Our median SDI (2.1 months) is similar to Porta's [19] of 2.0 months, as is the percentage of censored cases (14.6% in our series, compared to 16.1% in Porta's). Our results differ from those published by Christensen [17] who, after classifying the patients

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