Can IP practice change lung cancer outcomes?

By Naveed Saleh, MD, MS, for MDLinx
Published March 14, 2019

Key Takeaways

A tissue biopsy diagnosis obtained from a gatekeeper interventional pulmonology (IP) practice reduced the time it took to start treatment, according to results of a recent study published in Lung.

“Established IP programs offer a wide array of diagnostic tools, and based on this single-center study, may facilitate patient care from first abnormal imaging study to definitive therapy,” wrote the authors, led by Bryan S. Benn, MD, PhD, Pulmonary and Critical Care Medicine, University of California, Los Angeles, CA.

This retrospective study included a total of 87 consecutive patients (mean age: 69 years; any smoking history: 72%) presenting to a California-located, single-center IP clinic for analysis of a new imaging abnormality. Each patient received a diagnostic procedure that supported a diagnosis of lung cancer or metastatic thorax cancer.

The team excluded all patients seen and sent directly for surgery, sent for transthoracic needle aspiration biopsy, or followed by means of surveillance imaging.

The researchers found that a median of 27 days elapsed between diagnostic biopsy and treatment initiation, and a median of 53 total days elapsed from abnormal imaging to definitive treatment initiation. Moreover, patients waited a median of 17 days from imaging study until biopsy diagnosis. All values were adjusted for age.

“We hypothesized that obtaining a tissue biopsy diagnosis through a gatekeeper IP practice would facilitate referral for definitive treatment by decreasing wait time between these two time points, with potentially positive implications for patient staging and survival,” wrote the authors.

The most common diagnostic procedure (59%) performed by the clinicians was endobronchial ultrasound-guided transbronchial needle aspiration.

Non-small cell lung cancer, pulmonary adenocarcinoma, and squamous cell carcinoma comprised the most common diagnoses, with all lymph node biopsies in surgical patients cancer-free at excision.

In previous international studies spanning all healthcare systems, researchers have demonstrated a gamut in delays to care for patients with cancer. On the longer end of wait times, some Canadian patients, for instance, waited a median of 141 days between detection and initiation of chemotherapy. In another study, 256 subjects had to wait 208 days from start of symptoms to surgery. Wait times were found to be similarly long in Nordic countries.

Wait times in the United States were relatively shorter, although this result was based on data from Veterans Affairs hospitals, which may not be representative of care available to a wider American population.

The authors acknowledged that one limitation of their study was that it involved a single institution with specific efficiencies in place. Such idiosyncrasies could make it difficult to extend these results to other healthcare settings.

“This study presents, for the first time, the positive impact of a well-established, dedicated IP practice on the timely diagnosis and treatment of lung cancer,” the authors concluded. “Established IP programs offer a wide array of diagnostic tools, and based on this single-center study, may facilitate patient care from first abnormal imaging study to definitive therapy.”

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