Predictors of diagnostic delay and survival in a veteran population with lung cancer

A69

Background:
 Overall survival of veterans with lung cancer is inferior to the civilian population despite their universal access to health care services. The primary objective of this study is to assess the effects of imaging-to-diagnosis delays on survival for veterans with lung cancer. Our main hypothesis is that delay between first radiological abnormality and diagnosis is correlated with a worse prognosis.
 Methods:
 The study consisted of a retrospective chart review of 281 incident cases of lung cancer diagnosed at the Philadelphia VA Medical Center between 1998 and 2002. Cases were identified through the Philadelphia VA Tumor Registry Database and evaluated by chart review for age, gender,race, smoking history, lung cancer stage, histology, and patient comorbidities. The longest patient follow-up was five years. Survival was defined as the time from lung cancer tissue diagnosis to death or the last known date that the patient was reported to be alive. Treatment delay was defined as the median time from radiographic abnormality to pathologic diagnosis and treatment.
 Results:
 The median delay between initial abnormal imaging and a pathologic diagnosis was 38 days (mean 85 days, SD 235). For resectable patients, the median delay between initial imaging and surgery was 105 days (SD 122). About a third of all patients experience diagnostic delays of 90 days or greater. Patients with metastatic disease had more expedited workups and shorter treatment delays (mean delay for Stage IV disease was 56 days vs. 115 days for Stage I/II, p=.256) . Patients age 70 and older had the longest imaging-to-diagnosis time intervals with a mean delay of 132 days vs. 59 days for younger patients, ages 45 to 70 (p=.057). African Americans experienced longer delays than their Caucasian counterparts with regional (151 vs. 78 days) and advanced disease (74 vs. 35 days), although these differences were not statistically different. There were no statistical differences in overall survival by race and diagnostic delay when controlling for age and stage of disease. There was a trend for increased mortality in patients with early stage lung cancer who experience diagnostic delays greater than 90 days.
 Conclusion:
 There were no disparities in survival by treatment delay among veterans with lung cancer. Older age, early stage of disease, and race are significant predictors of diagnostic delays. Patients with metastatic disease experience expedited workups with no significant impact on survival. The results from this study will inform future interventions emphasizing early detection and treatment for lung cancer patients at risk for delayed care.