Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 4;16(6):e0252529.
doi: 10.1371/journal.pone.0252529. eCollection 2021.

Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis

Fernando Barata  1 , Paula Fidalgo  2 , Sara Figueiredo  3 , Fernanda S Tonin  4 , Filipa Duarte-Ramos  5   6
Affiliations

Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis

Fernando Barata et al. PLoS One. .

Abstract

Background: We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal.

Methods: Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson's chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0).

Results: Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55-140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients' admission until treatment ranged from 42-61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61-12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals.

Conclusions: Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.

PubMed Disclaimer

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Sara Figueiredo works at the Oncology-Medical Department, AstraZeneca Portugal. She had no role on the study design, data collection or analysis. The other authors have declared that no competing interests exist. The study’s medical writing was supported by AstraZeneca Portugal. AstraZeneca Portugal had no role on the study design, data collection or analysis. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Summary of the main stages and median lag times (days) for lung cancer diagnosis in Portugal (MTC: Multidisciplinary consultation).
See this image and copyright information in PMC

References

    1. Barta JA, Powell CA, Wisnivesky JP. Global Epidemiology of Lung Cancer. Ann Glob Health. 2019;85(1). doi: 10.5334/aogh.2419 - DOI - PMC - PubMed
    1. Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, et al. Progress in cancer mortality, incidence, and survival: a global overview. Eur J Cancer Prev. 2020. - PubMed
    1. The Global Cancer Observatory. Portugal—Globocan 2018 2019 [cited 2021 01 Feb 2021]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/620-portugal-fact-....
    1. Borges M, Gouveia M, Alarcao J, Sousa R, Teixeira E, Barata F, et al. Cost and Burden of Non-Small Cell Lung Cancer’s in Portugal. Value Health. 2014;17(7):A626. doi: 10.1016/j.jval.2014.08.2228 - DOI - PubMed
    1. Malalasekera A, Nahm S, Blinman PL, Kao SC, Dhillon HM, Vardy JL. How long is too long? A scoping review of health system delays in lung cancer. Eur Respir Rev. 2018;27(149). - PMC - PubMed

Publication types