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

Abstract

Abstract

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 1^st January 2014 and 31^st 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.