Lung cancer is the leading cause of cancer-related eaths worldwide and causes more deaths than do colorectal, breast, and prostate cancers combined.1
An estimated 155,870 Americans are expected to die of
lung cancer in 2017, and these deaths account for about
26% of all cancer deaths.1 The overall 5-year survival rate
for patients with lung cancer is 16.8%.2 However, this rate
varies considerably, from 54% for those with early-stage
cancer to 26.5% for those with locally advanced cancer
and 4% for those with distant metastases.2
The Institute of Medicine’s Committee on Quality
Health Care in America recognized timeliness of care
as 1 of 6 important dimensions of health care quality.3
Delays in timely diagnosis and treatment of cancer, especially lung cancer, can result in significant emotional
distress, impaired quality of life, increased use of health
care resources, and, arguably, increased cost of care.4 In
addition, delayed diagnosis of cancer can lead to negligence litigation.4
In the U.S., there are no federal standardized guidelines regarding timeliness of lung cancer care. In 2000,
the RAND Corporation, a research organization, published several quality indicators recommending lung cancer diagnoses be established within 2 months after initial
abnormal chest radiographs and treatment be offered
within 6 weeks after diagnosis.5
Using these recommendations as benchmarks, a qual-
ity improvement study was conducted to determine the
time lines of comprehensive lung cancer care at the Day-
ton VAMC in Ohio. The primary aim of the study was to
evaluate adherence to the RAND criteria (the only U.S.-
based guidelines) for the diagnosis and treatment of lung
cancer in Dayton VAMC patients. The secondary aim was
to assess the effect of preoperative cardiopulmonary reha-
bilitation on timeliness of treatment. The authors plan to
use the results of the study to guide and improve cancer
practices at the Dayton VAMC.
METHODS
The authors conducted a retrospective study of a series of
121 consecutive patients who had lung cancer that was
confirmed at the Dayton VAMC with a cytohistologic diagnosis between January 2011 and December 2013. The
study was approved by the Dayton VAMC Research and
Development committee and the Wright State University
Institutional Review Board. After data collection and review, all patient identifiers were replaced with sequential
numbering.
The Dayton VAMC is a 356-bed facility serving
16 counties and > 50,000 patients. Lung cancer diagnosis and management are collaboratively undertaken
by various Dayton VAMC departments, including pul-monology, radiology, interventional radiology, pathology, thoracic surgery, medical oncology, radiation
oncology, and palliative care. The facility, fully equipped
with scanners for positron emission tomography and
magnetic resonance imaging, provides comprehensive
cancer care without the need for referrals to outside facilities for any part of care from diagnosis to end of life.
The study patients were identified from the Dayton
VAMC tumor registry. Patients with only biopsy-confirmed
Timeliness of Lung Cancer
Diagnosis and Treatment
Ali Bukhari, MD; Geetika Kumar, MBBS; Radhika Rajsheker, MD;
and Ronald Markert, PhD
Most patients received timely histopathologic confirmation of diagnosis, but surgery
candidates faced significant delays in care in this quality improvement analysis.
4S • FEDERAL PRACTITIONER • FEBRUARY 2017 www.fedprac.com
Dr. Bukhari is chief resident of internal medicine at Wright Patterson Air
Force Base in Ohio. Dr. Kumar is the section chief of hematology and oncology at the Dayton VAMC; Dr. Rajsheker is a hematologist and medical oncologist; Dr. Markert is a professor of medicine and orthopedic surgery and
vice chair for research; and Dr. Bukhari is chief resident; all at Wright State
University-Boonshoft School of Medicine in Dayton, Ohio.
