Skip to main content

Using a Dedicated Interventional Pulmonology Practice Decreases Wait Time Before Treatment Initiation for New Lung Cancer Diagnoses

Abstract

Purpose

While there is significant mortality and morbidity with lung cancer, early stage diagnoses carry a better prognosis. As lung cancer screening programs increase with more pulmonary nodules detected, expediting definitive treatment initiation for newly diagnosed patients is imperative. The objective of our analysis was to determine if the use of a dedicated interventional pulmonology practice decreases time delay from new diagnosis of lung cancer or metastatic disease to the chest to treatment initiation.

Methods

Retrospective chart analysis was done of 87 consecutive patients with a new diagnosis of primary lung cancer or metastatic cancer to the chest from our interventional pulmonology procedures. Demographic information and time intervals from abnormal imaging to procedure and to treatment initiation were recorded.

Results

Patients were older (mean age 69) and former or current smokers (72%). A median of 27 days (1–127 days) passed from our diagnostic biopsy to treatment initiation. A median of 53 total days (2–449 days) passed from abnormal imaging to definitive treatment. Endobronchial ultrasound-guided transbronchial needle aspiration was the most commonly used diagnostic procedure (59%), with non-small cell lung cancer the majority diagnosis (64%). For surgical patients, all biopsy-negative lymph nodes from our procedures were cancer-free at surgical excision.

Conclusions

Compared to prior reports from international and United States cohorts, obtaining a tissue biopsy diagnosis through a gatekeeper interventional pulmonology practice decreases median delay from abnormal imaging to treatment initiation. This finding has the potential to positively impact patient outcomes and requires further evaluation.

This is a preview of subscription content, access via your institution.

Abbreviations

Cryo:

Flexible cryoprobe biopsy and tissue extraction

EBUS-TBNA:

Endobronchial ultrasound-guided biopsy transbronchial needle aspiration

ECH:

El Camino Hospital

EMN:

Electromagnetic navigation-guided biopsy

IP:

Interventional pulmonology

NSCLC:

Non-small cell lung cancer

PAMF:

Palo Alto Medical Foundation

SHN:

Sutter Health Network

References

  1. 1.

    National Cancer Institute Surveillance, Epidemiology, and end results program. http://seer.cancer.gov/statfacts/html/lungb.html. Accessed 18 Mar 2018

  2. 2.

    National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409

    Article  Google Scholar 

  3. 3.

    National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S (2013) Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 368(21):1980–1991

    Article  CAS  Google Scholar 

  4. 4.

    Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gatsonis CA, Gierada DS, Jain A, Jones GC, Mahon I, Marcus PM, Rathmell JM, Sicks J (2013) National Lung Screening Trial Research Team. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 369(10):920–931

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Eberth JM (2015) Lung cancer screening with low-dose CT in the United States. J Am Coll Radiol 12(12 Pt B):1395–1402

    Google Scholar 

  6. 6.

    Sox HC (2011) Better evidence about screening for lung cancer. N Engl J Med 365(5):455–457

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Doria-Rose VP, White MC, Klabunde CN et al (2012) Use of lung cancer screening tests in the United States: results from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 21(7):1049–1059

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Tanner NT, Silvestri GA (2015) What’s in a Number? When it comes to pulmonary nodules, it’s all about the number. Am J Respir Crit Care Med 192(10):1149–1150

    Article  PubMed  Google Scholar 

  9. 9.

    Gould MK, Tang T, Liu IL, Lee J, Zheng C, Danforth KN, Kosco AE, Di Fiore JL, Suh DE (2015) Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med 192(10):1208–1214

    Article  PubMed  Google Scholar 

  10. 10.

    Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e93S–e120S

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Tanner NT, Aggarwal J, Gould MK, Kearney P, Diette G, Vachani A, Fang KC, Silvestri GA (2015) Management of pulmonary nodules by community pulmonologists: a multicenter observational study. Chest 148(6):1405–1414

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Kanashiki M, Satoh H, Ishikawa H, Yamashita YT, Ohtsuka M, Sekizawa K (2003) Time from finding abnormality on mass-screening to final diagnosis of lung cancer. Oncol Rep 10(3):649–652

    PubMed  Google Scholar 

  13. 13.

    O’Rourke N, Edwards R (2000) Lung cancer treatment waiting times and tumour growth. Clin Oncol (R Coll Radiol) 12(3):141–144

    Article  Google Scholar 

  14. 14.

    Ellis PM, Vandermeer R (2011) Delays in the diagnosis of lung cancer. J Thorac Dis 3(3):183–188

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Koyi H, Hillerdal G (2002) Brandén E.Patient’s and doctors’ delays in the diagnosis of chest tumors. Lung Cancer 35(1):53–57

    Article  PubMed  Google Scholar 

  16. 16.

    Bilimoria KY, Ko CY, Tomlinson JS, Stewart AK, Talamonti MS, Hynes DL, Winchester DP, Bentrem DJ (2011) Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg 253(4):779–785

    Article  PubMed  Google Scholar 

  17. 17.

    Saint-Jacques N, Rayson D, Al-Fayea T, Virik K, Morzycki W, Younis T (2008) Waiting times in early-stage non-small cell lung cancer (NSCLC). J Thorac Oncol 3(8):865–870

    Article  PubMed  Google Scholar 

  18. 18.

    Liberman M, Liberman D, Sampalis JS, Mulder DS (2006) Delays to surgery in non-small-cell lung cancer. Can J Surg 49(1):31–36

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Van de Vosse D, Chowdhury R, Boyce A, Halperin R (2015) Wait times experienced by lung cancer patients in the BC Southern interior to obtain oncologic care: exploration of the intervals from first abnormal imaging to oncologic treatment. Cureus 7(9):e330

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Salomaa ER, Sällinen S, Hiekkanen H, Liippo K (2005) Delays in the diagnosis and treatment of lung cancer. Chest 128(4):2282–2288

    Article  PubMed  Google Scholar 

  21. 21.

    Gould MK, Ghaus SJ, Olsson JK, Schultz EM (2008) Timeliness of care in veterans with non-small cell lung cancer. Chest 133(5):1167–1173

    Article  PubMed  Google Scholar 

  22. 22.

    Schultz EM, Powell AA, McMillan A, Olsson JK, Enderle MA, Graham BA, Ordin DL, Gould MK (2009) Hospital characteristics associated with timeliness of care in veterans with lung cancer. Am J Respir Crit Care Med 179(7):595–600

    Article  PubMed  Google Scholar 

  23. 23.

    Shea AM, Curtis LH, Hammill BG, DiMartino LD, Abernethy AP, Schulman KA (2008) Association between the Medicare Modernization Act of 2003 and patient wait times and travel distance for chemotherapy. JAMA 300(2):189–196

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Yorio JT, Xie Y, Yan J, Gerber DE (2009) Lung cancer diagnostic and treatment intervals in the United States: a health care disparity? J Thorac Oncol 4(11):1322–1330

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Everitt S, Herschtal A, Callahan J, Plumridge N, Ball D, Kron T, Schneider-Kolsky M, Binns D, Hicks RJ, MacManus M (2010) High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose-positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer. Cancer 116(21):5030–5037

    Article  PubMed  Google Scholar 

  26. 26.

    Mohammed N, Kestin LL, Grills IS, Battu M, Fitch DL, Wong CY, Margolis JH, Chmielewski GW, Welsh RJ (2011) Rapid disease progression with delay in treatment of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 79(2):466–472

    Article  PubMed  Google Scholar 

  27. 27.

    Geiger GA, Kim MB, Xanthopoulos EP, Pryma DA, Grover S, Plastaras JP, Langer CJ, Simone CB 2nd, Rengan R (2014) Stage migration in planning PET/CT scans in patients due to receive radiotherapy for non-small-cell lung cancer. Clin Lung Cancer 15(1):79–85

    Article  PubMed  Google Scholar 

  28. 28.

    Christensen NL, Jekunen A, Heinonen S, Dalton SO, Rasmussen TR (2017) Lung cancer guidelines in Sweden, Denmark, Norway and Finland: a comparison. Acta Oncol 56(7):943–948

    Article  PubMed  Google Scholar 

  29. 29.

    Baldwin DR, White B, Schmidt-Hansen M, Champion AR, Melder AM, Guideline Development Group (2011) Diagnosis and treatment of lung cancer: summary of updated NICE guidance. BMJ 342:d2110

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Ettinger DS, Akerley W, Borghaei H, Chang AC, Cheney RT, Chirieac LR, D’Amico TA, Demmy TL, Govindan R, Grannis FW Jr, Grant SC, Horn L, Jahan TM, Komaki R, Kong FM, Kris MG, Krug LM, Lackner RP, Lennes IT, Loo BW Jr, Martins R, Otterson GA, Patel JD, Pinder-Schenck MC, Pisters KM, Reckamp K, Riely GJ, Rohren E, Shapiro TA, Swanson SJ, Tauer K, Wood DE, Yang SC, Gregory K, Hughes M (2013) National comprehensive cancer network. Non-small cell lung cancer, version 2.2013. J Natl Compr Canc Netw 11(6):645–653. (quiz 653)

    Article  Google Scholar 

  31. 31.

    Ost DE, Jim Yeung SC, Tanoue LT, Gould MK (2013) Clinical and organizational factors in the initial evaluation of patients with lung cancer: diagnosis and management of lung cancer, 3rd edn: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e121S–e141S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM (2013) Executive Summary: Diagnosis and management of lung cancer, 3rd edn: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):7S–37S

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Vilmann P, Clementsen PF, Colella S, Siemsen M, De Leyn P, Dumonceau JM, Herth FJ, Larghi A, Vazquez-Sequeiros E, Hassan C, Crombag L, Korevaar DA, Konge L, Annema JT (2015) Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Endoscopy 47(6):545–559

    Article  PubMed  Google Scholar 

  34. 34.

    Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC (2013) Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e211S–e250S

    Article  Google Scholar 

  35. 35.

    Navani N, Nankivell M, Lawrence DR, Lock S, Makker H, Baldwin DR, Stephens RJ, Parmar MK, Spiro SG, Morris S, Janes SM (2015) Lung-BOOST trial investigators. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial. Lancet Respir Med 3(4):282–289

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Yasufuku K, Nakajima T, Fujiwara T, Chiyo M, Iyoda A, Yoshida S, Suzuki M, Sekine Y, Shibuya K, Yoshino I (2008) Role of endobronchial ultrasound-guided transbronchial needle aspiration in the management of lung cancer. Gen Thorac Cardiovasc Surg 56(6):268–276

    Article  PubMed  Google Scholar 

  37. 37.

    Folch E, Majid A (2013) Point: are> 50 supervised procedures required to develop competency in performing endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal staging? Yes. Chest 143(4):888–891

    Article  PubMed  Google Scholar 

  38. 38.

    Fernández-Villar A, Leiro-Fernández V, Botana-Rial M, Represas-Represas C, Núñez-Delgado M (2012) The endobronchial ultrasound-guided transbronchial needle biopsy learning curve for mediastinal and hilar lymph node diagnosis. Chest 141(1):278–279

    Article  PubMed  Google Scholar 

  39. 39.

    Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B, Studnicka M (2012) Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield. Respir Med 106(5):710–715

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dominick L. Frosch, PhD for assistance with statistical analysis.

Funding

No sources of funding to report.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Bryan S. Benn.

Ethics declarations

Conflict of interest

All authors report no disclosures and no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Benn, B.S., Parikh, M., Tsau, P.H. et al. Using a Dedicated Interventional Pulmonology Practice Decreases Wait Time Before Treatment Initiation for New Lung Cancer Diagnoses. Lung 197, 249–255 (2019). https://doi.org/10.1007/s00408-019-00207-6

Download citation

Keywords

  • Interventional pulmonology
  • Bronchoscopy
  • Lung cancer
  • Chest imaging
  • Wait time