Delays to surgery in non-small-cell lung cancer

In Canada, waiting times for referral and surgery exist for both benign and malignant disease. We attempted to evaluate the length of various waiting times for surgery as well as their association with surgical stage in patients with non-small-cell lung cancer (NSCLC).

This observational study consisted of a retrospective review of data for all patients who underwent an operation with the intent to cure NSCLC between Jan. 1, 1993, and Dec. 31, 2002, at the Montreal General Hospital, McGill University Health Centre, Montréal, Que. Time intervals between multiple preoperative points and surgery were calculated. The patients were then linked via universal health care insurance numbers with data from the centralized provincial inclusive health care database. This allowed the calculation of the precise interval between the patients' first contact with a physician for symptoms related to their malignancy and surgery. Mean time intervals were then compared with surgical stage.

We found adequate data for time interval analysis over 10 years for 256 patients who had undergone surgery with intent to cure. The distribution of patients by TNM stage was as follows: stage I, 144 patients (56.3%); stage II, 47 patients (18.4%); stage III, 41 patients (16.0%); and stage IV, 24 patients (9.4%). Mean and median time intervals between initial contact with physician or first onset of symptoms relating to lung cancer and surgery were 208 (standard deviation [SD] 313) days and 109 days, respectively. Mean and median time intervals between initial contact with the thoracic surgeon and surgery were 104 (SD 99) days and 82 days, respectively. No detrimental effect was observed between time to surgery and surgical stage in patients with NSCLC.

Excessive preoperative waiting times before attempts at curative surgical resection for NSCLC exist in our centre. These intervals are exceptionally long, multifactorial and cause for concern.