The study of association between duration of diagnosis to treatments and mortality among advanced stage non-small cell lung cancer in Saraburi hospital
Keywords:
Non-small cell lung cancer, Advanced stage CA lung, duration of diagnosis and treatment, mortality rateAbstract
Lung cancer accounts for high mortality rate. The study aims to investigate the association between duration of diagnosis to treatments, other factors, and mortality among 255 patients diagnosed with advanced stage non-small cell lung cancer (NSCLC) from 1st January 2014 to 31st December 2019. This is a retrospective cohort study. Risks of dying from lung cancer were assess using Cox with time varying covariates. Patient data was obtained from electronic medical records and the National Cancer Registry of Thailand. The mortality rate of lung cancer in Saraburi province was 1.5 per 100 person-month and 1-year, 3-year, and 5-year mortality was 58.8%, 91.3% and 95% respectively. In univariate analysis, mortality of lung cancer is associated with longer waiting period for any services. The mortality rate is almost 3 times higher if the waiting time between the 1st visit and the diagnosis is more than 4 weeks, compared to shorter waiting time [HR 2.81 (95%CI 1.95-4.04)]. Longer waiting period for tissue diagnosis more than 2 weeks is also associated with higher mortality [HR 2.79 (95%CI 1.85-4.21)]. Furthermore, the waiting period between the diagnosis and the 1st treatment for more than 4 weeks and the waiting period between the 1st visit and the 1st treatment for more than 6 weeks are associated with higher mortality rate [HR 1.50 (95%CI 1.11-2.02) and HR 2.63 (95%CI 1.70-4.08) respectively]. In multivariate analysis, these timing factors do not reach statistical significance but patients who did not receive any systemic treatments demonstrate the strongest mortality rate [adjusted HR 4.10 (95%CI 2.32-7.24)]. Among 172 patients receiving treatments for lung cancer, those receiving external beam radiation therapy has higher mortality rate than others [HR 3.00 (95%CI 1.12-8.02)]. In conclusion, longer waiting period in any process show trends to impact mortality rate although did not reach statistical significance in multivariate analysis. The other cell types apart from adenocarcinoma and squamous cell carcinoma associate with higher mortality. Patients who did not receive systemic therapy have higher mortality rate than those who received.
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