Association between duration of diagnosis to treatments and mortality among advanced stage non-small cell lung cancer patients in Saraburi Hospital


  • Panpicha Chantasartrassamee Resident in training, Department of Medicine, Saraburi Provincial Hospital
  • Voralak Vichapat Division of Medical Oncology, Department of Medicine, Saraburi Provincial Hospital


Non-small cell lung cancer, Advanced stage CA lung, Duration of diagnosis and treatment, Mortality



Lung cancer accounts for a high mortality rate. This study aimed to investigate the association between the duration of the process from diagnosis to treatment, other factors, and mortality. This is a retrospective cohort study among 255 patients diagnosed with advanced stage non-small cell lung cancer (NSCLC) in Saraburi Hospital between 1st January 2014 and 31st December 2019.  The risks of dying from lung cancer were assessed using the Cox scale, with time varying covariates. The patient information 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 one-year, three-year, and five-year mortality rates at was 58.8%, 91.3% and 95%, respectively. In univariate analysis, the mortality of lung cancer was associated with longer waiting period for any services. The mortality rate was almost three times higher if the waiting time between the first visit and the diagnosis was more than four weeks, compared to shorter waiting time [HR 2.81 (95%CI 1.95-4.04)]. The longer waiting period for tissue diagnosis was more than two weeks was also associated with higher mortality [HR 2.79 (95%CI 1.85-4.21)]. Furthermore, the waiting period between the diagnosis and the first treatment for more than four weeks and the waiting period between the first visit and the first treatment for more than six weeks were 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 did not have statistical significance but patients who did not receive any treatments demonstrated the strongest mortality predictor [adjusted HR 4.10 (95%CI 2.32-7.24)]. Patients with histological subtypes, other than adenocarcinoma or squamous cell carcinoma also showed a high risk of mortality [HR 3.00 (95%CI 1.12-8.02)]. The longer waiting periods to treat lung cancer in any services showed higher trends to impact mortality rate although they did not have statistical significance in multivariate analysis. Patients who did not receive any systemic therapy had a higher mortality rate than those who received systemic therapy.


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Imsamran W, Pattatang A, Supaattagorn P, et al. Cancer in Thailand volume IX, 2013-2015. Bangkok: NCIB. 2018.

National Cancer Institute. Hospital-based cancer registry 2561. Department of Medical Services Mistry of Public Health; 2019. Contract No.: 1.

Mountain CF. The international systemfor staging lung cancer. Semin Surg Oncol 2000;18:106.

Venuta F, Diso D, Onorati I, et al. Lung cancer in elderly patients. J Thorac Dis 2016;8:S908-14.

Tas F, Ciftci R, Kilic L, et al. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett 2013;6:1507-13.

Feng SH, Yang ST. The new 8th TNM staging system of lung cancer and its potential imaging interpretation pitfalls and

limitations with CT image demonstrations. Diagnostic Interv Radiol 2019;25:270-9.

Lichtman SM, Wildiers H, Chatelut E, et al. International society of geriatric oncology chemotherapy taskforce: Evaluation of chemotherapy in older patients - An analysis of the medical literature. J Clin Oncol 2007;25:1832-43.

Ito Y, Ohno Y, Rachet B, et al. Cancer survival trends in Osaka, Japan: The influence of age and stage at diagnosis. Jpn J Clin Oncol 2007;37:452-8.

Tammemagi CM, Neslund-Dudas C, Simoff M, et al. Smoking and lung cancer survival: The role of comorbidity and treatment.

Chest 2004;125:27-37.

Yoshino I, Kawano D, Oba T, et al. Smoking status as a prognostic factor in patients with stage I pulmonary adenocarcinoma. Ann Thorac Surg 2006;81:1189-93.

Mäkitaro R, Pääkko P, Huhti E, et al. Prospective population-based study on the survival of patients with lung cancer. Eur Respir J 2002;19:1087-92.

Joshi A, Mishra R, Desai S, et al. Molecular characterization of lung squamous cell carcinoma tumors reveals therapeutically relevant alterations. Oncotarget 2021;12: 578-88.

Vaid AK, Gupta A, Momi G. Overall survival in stage IV EGFR mutation-positive NSCLC: Comparing first-, second- and

third-generation EGFR-TKIs (Review). Int J Oncol 2021;58:171-84.

Salloum RG, Smith TJ, Jensen GA, et al. Survival among non-small cell lung cancer patients with poor performance status after first line chemotherapy. Lung Cancer 2012;77:545-9.

Owusuaa C, Dijkland SA, Nieboer D, et al. Predictors of mortality in patients with advanced cancer—a systematic review and meta-analysis. Cancers (Basel) 2022;14:1-20.

Obenauf AC, Massagué J. Surviving at a distance: Organ-specific metastasis. Trends cancer 2015;1:76-91.

Gómez OH, Paul AM, Granados ALO, et al. “High tumor burden” in metastatic non-small cell lung cancer: Defining the concept. Cancer Manag Res 2021;13: 4665-70.

Gomez DR, Liao KP, Swisher SG, et al. Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival. Radiother Oncol 2015;115:257-63.

Vichapat V. Prognostic factors and overall survival of advanced stage NSCLC patients in Saraburi Hospital. J Dept Med Ser 2021;46:182-9.

Ha D, Ries AL, Montgrain P, et al. Time to treatment and survival in veterans with lung cancer eligible for curative intent therapy. Respir Med 2018;141:172-9.

Bozcuk H, Martin C. Does treatment delay affect survival in non-small cell lung cancer? A retrospective analysis from a single UK centre. Lung Cancer 2001;34: 243-52.

TCB Report Online. Thai population cancer database. National Cancer Institute do?mode=initialApplication (2563).

Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM Classification for lung cancer. J Thorac Oncol 2016;11:39-51.

Ruhe C. Estimating survival functions after stcox with time-varying coefficients. STATA J 2016;16:867-79.

StataCorp, Stata Statistical Software: Release 14. College Station, TX: StataCorp LP. 2015.

Brule SY, Al-Baimani K, Jonker H, et al. Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not. Lung Cancer 2016;97:15-21.

Cheng TY, Cramb SM, Baade PD, et al. The international epidemiology of lung cancer: latest trends, disparities, and tumor characteristics. J Thorac Oncol 2016. Oct;11:1653-71.

Visbal AL, Williams BA, Nichols FC, et al. Gender differences in non-small-cell lung cancer survival: An analysis of 4,618 patients diagnosed between 1997 and 2002. Ann Thorac Surg 2004;78:209-15.

Islam KMM, Jiang X, Anggondowati T, et al. Comorbidity and survival in lung cancer patients. Cancer Epidemiol Biomarkers

Prev. 2015;24:1079-85.

Travis WD, Brambilla E, Geisinger KR. Histological grading in lung cancer: One system for all or separate systems for each histological type? Eur Respir J 2016;47:720-3.

Fukuoka M, Wu YL, Thongprasert S, et al. Biomarker analyses and final overall survival results from a phase III, randomized, open-label, first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non - small-cell lung cancer in Asia (IPASS). J Clin Oncol 2011;29:2866-74.

Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 2011;12:735-42.

Vinod KS, Chandra A, Berthelsen A, et al. Does timeliness of care in Non-Small Cell Lung Cancer impact on survival?, Lung Cancer 2017;112:16-24.

Labbé C, Anderson M, Simard Msc S, et al. Wait times for diagnosis and treatment of lung cancer: A single-centre experience. Curr Oncol 2017;24:367-73.

Tsai HC, Kung TP, Kuo YW, et al. Effect of time interval from diagnosis to treatment for non-small cell lung cancer on survival:

A national cohort study in Taiwan. BMJ Openh 2020;10:1-10.

Peters S, Bexelius C, Munk V, et al. The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat Rev 2016;45:139-62.






Original Article (บทความวิจัย)