Education, Teaching, and Quality Improvement |

Logistics of Lung Cancer Diagnosis and Staging for Patients in an Academic Medical Center FREE TO VIEW

Alicia Alterio; Debra Maddox; Karl Uy; Geoffrey Graeber; Syed Quadri, MS
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Surgery, UMass Memorial Medical Center, Worcester, MA

Chest. 2014;146(4_MeetingAbstracts):548A. doi:10.1378/chest.1994868
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SESSION TITLE: Cost and Quality Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Non-small cell lung cancer (NSCLC), imposes significant financial costs to the healthcare system. Furthermore, as a complex disease often treated in a multidisciplinary fashion, patients have multiple visits with different providers for diagnosis, staging, and treatment planning. We aim to quantify this burden for patients with suspected NSCLC in terms of healthcare related visits from initial presentation to the start of treatment.

METHODS: A prospective database of consecutive patients seen in 2012 for evaluation of suspected lung cancer in a multidisciplinary lung cancer clinic was retrospectively reviewed. Of 129 new patients seen in 2012, 28 were excluded as they had initiation of care elsewhere prior to transfer to our institution or they were found to have diagnoses other than NSCLC. We determined the total number of visits between initial presentation and the initiation of definitive treatment or palliative care. Visits not associated with NSCLC were excluded.

RESULTS: Charts from 47 men and 54 women with a mean age of 66.4 (43-88) were reviewed. NSCLC related visits were tabulated for each patient. NSCLC stage distribution and median number of visits: Stage I: 25.8% (12 visits), Stage II: 13.9% (12), Stage III: 22.8% (11.3), Stage IV: 37.6% (10). Median visits per patient = 11 (1-39). Distribution of visits: radiology and laboratory tests 36.3%, medical oncology 10.6%, thoracic surgery 10.4%, primary care 10%, pulmonary medicine 8.3%, outpatient procedures 7.5%, inpatient procedures and admissions 5%, radiation oncology 4.4%, other medical specialists 3.2%, and emergency department visits 1.6%. The median time from presentation to initiation of treatment or palliative care was 61 days.

CONCLUSIONS: Patients' stage at the time of diagnosis had little effect on the number of visits to hospital or clinic. More than two months passed from first presentation to initiation of definitive treatment or palliative care. Based on the number of healthcare associated visits, NSCLC imposes substantial logistical challenges to patients and likely affects their quality of life and satisfaction.

CLINICAL IMPLICATIONS: We plan to use these data to design a streamlined integrated lung cancer program that not only reduces facility costs but also improves patients' quality of life and satisfaction by reducing both the number of visits and the delay between presentation and treatment.

DISCLOSURE: The following authors have nothing to disclose: Alicia Alterio, Debra Maddox, Karl Uy, Geoffrey Graeber, Syed Quadri

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