Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review

被引：26

作者：

Hall, Helen ^{[1
]}

Tocock, Adam ^{[2
]}

Burdett, Sarah ^{[3
]}

Fisher, David ^{[3
]}

Ricketts, William M. ^{[4
]}

Robson, John ^{[5
]}

Round, Thomas ^{[6
]}

Gorolay, Sarita ^{[7
]}

MacArthur, Emma ^{[8
]}

Chung, Donna ^{[8
]}

Janes, Sam M. ^{[1
]}

Peake, Michael D. ^{[8
,9
]}

Navani, Neal ^{[1
,10
]}

机构：

[1] UCL, Lungs Living Res Ctr, UCL Resp, London, England

[2] Barts Hlth NHS Trust, Barts Hlth Knowledge & Lib Serv, London, England

[3] UCL, MRC Clin Trials Unit UCL, London, England

[4] Barts Hlth NHS Trust, Dept Resp Med, London, England

[5] Queen Mary Univ London, Ctr Primary Care & Publ Hlth, London, England

[6] Kings Coll London, Sch Populat Hlth & Environm Sci, London, England

[7] London Borough Tower Hamlets, XX Pl Hlth Ctr, London, England

[8] Univ Coll London Hosp NHS Fdn Trust, Ctr Canc Outcomes, North Cent & North East London Canc Alliances, London, England

[9] Univ Leicester, Dept Resp Med, Leicester, Leics, England

[10] Univ Coll London Hosp, Dept Thorac Med, London, England

来源：

THORAX | 2022年 / 77卷 / 08期

关键词：

non-small cell lung cancer; TREATMENT INITIATION; WAITING-TIMES; STAGE; DIAGNOSIS; SURVIVAL; CARE; IMPACT; DELAY; TIMELINESS; MORTALITY;

D O I：

10.1136/thoraxjnl-2021-216865

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. Methods Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. Results Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease. Conclusion There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.

引用

页码：762 / 768

页数：7

共 73 条

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