Length of Diagnostic Delay in Patients with Non-small-cell Lung Cancer

Introduction Despite advances in diagnostic techniques and treatment, lung cancer is the leading cause of cancer death worldwide and in Cuba. Prompt initiation of cancer therapy depends on rapid diagnostic confirmation; however, most patients are diagnosed at an advanced stage. In the Cuban health system, primary, secondary and tertiary levels of care are interrelated; patients may seek care at any level or may be referred from one to another. Lung cancer diagnoses are confirmed at the tertiary level. Objective Determine the length of diagnostic delay in patients diagnosed with non-small-cell lung cancer (NSCLC) at a tertiary care facility in Havana, Cuba, as well as mean diagnostic delay attributable to the patient and to the health system by level of care. Methods A descriptive observational study of 96 patients with a cytologically and/or histologically confirmed diagnosis of non-small-cell lung cancer was conducted in 2005-2007. Patients initially sought care for disease symptoms at primary, secondary or tertiary levels in the Cuban public health system, but diagnosis of all patients was confirmed at a specialized tertiary care facility. Total diagnostic delay was calculated as the time elapsed from onset of symptoms to confirmation of NSCLC diagnosis. Variables also included diagnostic delay attributable to the patient and diagnostic delay attributable to the health system by level of care. Data were arranged in tables and analyzed by absolute value, percentage, mean, and standard deviation. Results Of the 96 patients studied, 69% were male, and 54% were aged 50-69 years. Fifty-five percent of patients sought medical care within 15 days of onset of symptoms, 21% within 16-30 days, and 3% waited >90 days. Mean diagnostic delay attributable to the patient was 18.19 +/- 3.45 days while mean diagnostic delay attributable to the health system was 61.63 +/- 18.50 days, and overall diagnostic delay was 73.13 +/- 17.53 days. For the 71% of patients seen in primary care, mean diagnostic delay was 29.51 +/- 4.53 days; for the 45% seen exclusively or additionally at the secondary level, mean diagnostic delay was 24.45 +/- 7.31 days. Upon admission at the tertiary care level, mean diagnostic confirmation delay was 18.23 +/- 3.68 days. Conclusions Diagnostic delay of lung cancer patients in this study was prolonged. Appropriate strategies are needed for reducing this delay.