Reasons for delay in diagnosis and treatment of lung cancer among patients in Lublin Voivodeship who were consulted in Thoracic Surgery Department

Abstract

Introduction: Despite the progress which has been made in the diagnosis and treatment of lung cancer, it is still one of the main causes of death in both men and women. The introduction of new therapeutic modalities did not improve the 5-year survival results of lung cancer patients. The Lublin Voivodeship is a sparsely-inhabited area with little urbanization and a population of about 2.2 million people. Only 46.8% of its citizens live in the towns, while the national average is 61.9%.

Objectives: The aim of the study was to compare the differences in the periods of time and reasons for delay in diagnosis and initiation of treatment of lung cancer among patients who are inhabitants of the rural and urban regions of Lublin Voivodeship, and who were consulted in Thoracic Surgery Department.

Materials and methods: 300 lung cancer patients who were consulted in the Thoracic Surgery Outpatient Clinic or who were hospitalized in the Department of Thoracic Surgery in the period between 2 January 2010 - 7 January 2011 were included in the study. Delays were calculated for two periods of time: 1) time from the first signs of the disease to the first medical examination; 2) the time from the first visit to a doctor to the start of treatment, or disqualification from the causative treatment. The time of the first delay for the urban and rural populations was similar and ranged from 2-37 weeks and 2-23 weeks, respectively. Lack of time and disregard of signs of disease were the most commonly reasons given for the first delay among rural residents. The urban population indicated fear and lack of time as the main reasons of delay. Assessment of the second reason for delay was possible thanks to a specially designed research protocol which gathered the main reasons of delay in several subgroups that enabled their statistical evaluation. The length of second period was similar for both populations.

Results: There were no significant differences in the length of the time of delay between the two assessed groups. In both groups, delays dependent on poor healthcare access were similar. Among rural inhabitants, the most often reasons of delay were waiting for hospital admission and re-bronchoscopy. In the urban population, the most common reasons for delay were waiting for hospitalization and CT procedure.

Conclusions: The results of the presented research allowed the following conclusions to be drawn: between the two assessed groups there were no differences in the length of the time of delay; 2) delays in diagnosis and treatment were too long for the patients and could affect the severity of the disease and final prognosis; 3) there is a need for intensification of information campaigns on lung cancer in order to reduce the delays dependent on patients, and to improve the cooperation of family doctors, pulmonologists, thoracic surgeons and oncologists.