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. 2021 Dec 23:27:1610041.
doi: 10.3389/pore.2021.1610041. eCollection 2021.

Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary

Zoltan Kiss  1 , Krisztina Bogos  2 , Lilla Tamási  3 , Gyula Ostoros  2 , Veronika Müller  3 , László Urbán  4 , Nóra Bittner  5 , Veronika Sárosi  6 , Aladár Vastag  1 , Zoltán Polányi  1 , Zsófia Nagy-Erdei  1 , Kata Knollmajer  1 , Máté Várnai  1 , Balázs Nagy  7 , Krisztián Horváth  7 , György Rokszin  8 , Zsolt Abonyi-Tóth  8   9 , Zsófia Barcza  10 , Judit Moldvay  11   12 , Gabriella Gálffy  13 , Zoltán Vokó  7
Affiliations

Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary

Zoltan Kiss et al. Pathol Oncol Res. .

Abstract

Objective: This study aimed to examine the characteristics of the lung cancer (LC) patient pathway in Hungary during a 6-years period. Methods: This nationwide, retrospective study included patients newly diagnosed with LC (ICD-10 C34) between January 1, 2011, and December 31, 2016, using data from the National Health Insurance Fund (NHIF) of Hungary. The following patient pathway intervals were examined: system, diagnostic and treatment interval by age, gender, tumor type, study year and first-line LC therapy. Results: During the 6-years study period, 17,386 patients had at least one type of imaging (X-ray or CT/MRI) prior to diagnosis, and 12,063 had records of both X-ray and CT/MRI. The median system interval was 64.5 days, and it was 5 days longer among women, than in men (68.0 vs. 63.0 days). The median system interval was significantly longer in patients with adenocarcinoma compared to those with squamous cell carcinoma or small cell lung cancer (70.4 vs. 64.0 vs. 48.0 days, respectively). Patients who received surgery as first-line treatment had significantly longer median system intervals compared to those receiving chemotherapy (81.4 vs. 62.0 days). The median system interval significantly increased from 62.0 to 66.0 days during the 6-years study period. Conclusion: The LC patient pathway significantly increased in Hungary over the 6-years study period. There were no significant differences in the length of the whole LC patient pathway according to age, however, female sex, surgery as first-line treatment, and adenocarcinoma were associated with longer system intervals.

Keywords: episode of care; lung cancer; patient pathway; system interval; time to treatment.

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Conflict of interest statement

ZK, AV, ZP, ZN-E, KK, and MV are employees of MSD Pharma Hungary Ltd. MV is a research fellow at Semmelweis University. KH is a research fellow at Eötvös Loránd University. BN and ZV are employees at Eötvös Loránd University where their contribution to this project was financially compensated. KB and GO are employees of National Korányi Institute of Pulmonology and have received speaker honorarium from MSD Hungary. GG is employee of Oncology Center of Törökbálint and has received speaker honorarium from MSD Hungary. GR and ZA-T are employees of RxTarget Ltd. where their contribution to this project was financially compensated. ZB is employee of Syntesia Ltd. and her contribution to this project was financially compensated. The programme is financed by MSD Pharma Hungary Ltd. JM was supported by the Hungarian Brain research Program (grant 2017-1.2.1-NKP-2017-00002), and the Hungarian NRDI Office (grant K-129065). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from MSD Pharma Hungary Ltd. The funder had the following involvement with the study: development of study design, data collection, data analysis, interpretation of data, the writing of this article and the decision to submit it for publication.

Figures

FIGURE 1
FIGURE 1
Milestones for defining diagnostic, treatment, and system intervals. The diagnostic interval is defined as the interval between the first suspicious image and the first record of C34; the treatment interval is defined as the period between the date of first C34 ICD code to the date of first-line therapy initiation; and the system interval is the sum of the diagnostic and treatment intervals. The diagnostic imaging interval is the period between the date of the first X-ray and the date of the first CT/MRI; the diagnostic biopsy interval is the period between the date of the first CT/MRI and the date of the first record of C34.
FIGURE 2
FIGURE 2
The distribution of the timing of X-ray, CT (or MRI), biopsy and initiation of first-line therapy in relation to the date of the first C34-ICD 10 code in group A patients.
FIGURE 3
FIGURE 3
Median system intervals (the interval between the date of the first suspicious image and the date of the initiation of first-line therapy) in group A lung cancer patients by sex, age, histology of lung cancer, type of first-line therapy, study year, and main Hungarian regions, detailing the median, IQRs, number of patients with mean age (with SD) of the analysed subgroups.
FIGURE 4
FIGURE 4
Mean diagnostic imaging intervals (period between the date of the first X-ray to the date of the first CT/MRI), diagnostic biopsy intervals (period between the date of the first CT/MRI to the date of the first record of biopsy), treatment intervals (period between the date of the first C34 ICD code to the date of first-line therapy initiation) and system intervals (sum of the diagnostic and treatment intervals–period between the first suspicious image and the first day of therapy) in group B lung cancer patients.
See this image and copyright information in PMC

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