CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(03): 266-273
DOI: 10.1055/s-0043-1762597
Original Article
Lung Cancer

Delays in Lung Cancer Diagnosis: Observations from a Tertiary Care Centre in Kerala, India

Merin Yohannan
1   Department of Pulmonary Medicine, Government Medical College, Kottayam, Kerala, India
2   Department of Pulmonary Medicine, Mar Sleeva Medicity, Palai, Kottayam, Kerala, India
,
Kiran Vishnu Narayan
1   Department of Pulmonary Medicine, Government Medical College, Kottayam, Kerala, India
3   Department of Pulmonary Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
,
Kummannoor Parameswaran Pillai Venugopal
1   Department of Pulmonary Medicine, Government Medical College, Kottayam, Kerala, India
,
Sajitha Musthafa
1   Department of Pulmonary Medicine, Government Medical College, Kottayam, Kerala, India
› Author Affiliations
Funding None.

Abstract

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Merin Yohannan

Introduction Timely diagnosis of lung cancer is critical because treatment outcomes correspond to the stage of disease. This study identified patient and physician determined reasons for diagnostic delays.

Materials and Methods This was an observational cross-sectional study, conducted at a tertiary care institution in South India, for 12 months. From 207 consecutively selected patients, with a presumptive lung cancer diagnosis, 150 were enrolled utilizing a prefixed questionnaire. The time intervals from appreciation of initial respiratory symptoms to a final tissue diagnosis were defined sequentially as approach interval, referral interval, and diagnostic interval and factors causing delay in each interval were identified.

Results In a state with 100% literacy, the mean time to approach a doctor was 8 weeks (range: 0–336 days; SD: 7.95) with a delay seen in 52% of the study group. Referring a suspect lung cancer diagnosis to a specialist, took an average of 4.98 weeks (range: 1–26 weeks; SD: 5.64) with referral delays in 47.3% of patients. The mean diagnostic interval was 9.21 days (range: 3–41 days; SD: 7.18) and 16.7% of cases had diagnostic delays in spite of a definite procedure.

Conclusion In a tuberculosis endemic location, empirical treatment with anti-tuberculosis therapy and prolonged antibiotic courses without serially monitoring the course of disease are responsible for referral delays. Also, 88.2% of the total females studied, presented late due to family and work pressures, fear of being stigmatized and being on prolonged home remedies. A wider dissemination and awareness on lung cancer are needed especially among females. A low threshold to reinvestigate and an early referral to a pulmonary or lung cancer specialist, when expected clinicoradiological improvement is lacking, in microbiologically negative tuberculosis should be highlighted.

Supplementary Material



Publication History

Article published online:
09 June 2023

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  • References

  • 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
  • 2 Malik PS, Raina V. Lung cancer: prevalent trends & emerging concepts. (Editorial) Indian J Med Res 2015; 141 (01) 5-7
  • 3 Amma JP, Sebastian PJ. Burden of cancers: Registry based data from Kerala, India. Health Systems. March 2017. https://api.semanticscholar.org/CorpusID:79647925
  • 4 National Cancer Registry Program. Three year report of Population Based Cancer Registries 2012–2014. Report of 27 PBCRs. 2016. Bangalore: NCDIR-NCRP.
  • 5 Emmerick ICM, Singh A, Powers M, Lou F, Lin P, Maxfield M. et al. Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis. Rev Saude Publica 2021; 55: 112 https://doi.org/10.11606/s1518-8787.2021055003345
  • 6 Heist RS, Engelman JA. SnapShot: non-small cell lung cancer. Cancer Cell 2012; 21 (03) 448.e2 DOI: 10.1016/j.ccr.2012.03.007.
  • 7 Mathur P, Sathishkumar K, Chaturvedi M. et al; ICMR-NCDIR-NCRP Investigator Group. Cancer statistics, 2020: report from National Cancer Registry Programme, India. JCO Glob Oncol 2020; 6: 1063-1075
  • 8 Mohan A, Garg A, Gupta A. et al. Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center. Lung India 2020; 37 (03) 190-197
  • 9 Chaudhuri AD. Recent changes in technical and operational guidelines for tuberculosis control programme in India - 2016: a paradigm shift in tuberculosis control. J Assoc Chest Physicians 2017; 5: 1-9
  • 10 Chatterjee S, Misra S, Das I. et al. A cross-sectional study on different time intervals from the appreciation of symptoms to final diagnosis in inoperable primary lung cancer: an Eastern Indian experience. J Assoc Chest Physicians 2016; 4: 63-70
  • 11 Suspected cancer: recognition and referral. London: National Institute for Health and Care Excellence (NICE); 2021 Jan 29. (NICE Guideline, No. 12.) Accessed Jan 4, 2023, at: https://www.ncbi.nlm.nih.gov/books/NBK555330
  • 12 The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. BTS recommendations to respiratory physicians for organising the care of patients with lung cancer. Thorax 1998; 53 (suppl 1) S1-S8
  • 13 Chandra S, Mohan A, Guleria R, Singh V, Yadav P. Delays during the diagnostic evaluation and treatment of lung cancer. Asian Pac J Cancer Prev 2009; 10 (03) 453-456
  • 14 Jindal SK, Behera D. Clinical spectrum of primary lung cancer: review of Chandigarh experience of 10 years. Lung India 1990; 8: 94-98
  • 15 Salomaa ER, Sällinen S, Hiekkanen H, Liippo K. Delays in the diagnosis and treatment of lung cancer. Chest 2005; 128 (04) 2282-2288
  • 16 Koyi H, Hillerdal G, Brandén E. Patient's and doctors' delays in the diagnosis of chest tumors. Lung Cancer 2002; 35 (01) 53-57
  • 17 Sulu E, Tasolar O, Berk Takir H, Yagci Tuncer L, Karakurt Z, Yilmaz A. Delays in the diagnosis and treatment of non-small-cell lung cancer. Tumori 2011; 97 (06) 693-697
  • 18 Smith SM, Campbell NC, MacLeod U. et al. Factors contributing to the time taken to consult with symptoms of lung cancer: a cross-sectional study. Thorax 2009; 64 (06) 523-531
  • 19 Sachdeva R, Sachdeva S. Delay in diagnosis amongst carcinoma lung patients presenting at a tertiary respiratory centre. Clin Cancer Investig J 2014; 3: 288-292
  • 20 Buccheri G, Ferrigno D. Prognostic factors in lung cancer: tables and comments. Eur Respir J 1994; 7 (07) 1350-1364
  • 21 Buccheri G, Ferrigno D. Lung cancer: clinical presentation and specialist referral time. Eur Respir J 2004; 24 (06) 898-904
  • 22 Ramachandran K, Thankagunam B, Karuppusami R, Christopher DJ. Physician related delays in the diagnosis of lung cancer in India. J Clin Diagn Res 2016; 10 (11) OC05-OC08
  • 23 Singh VK, Chandra S, Kumar S, Pangtey G, Mohan A, Guleria R. A common medical error: lung cancer misdiagnosed as sputum negative tuberculosis. Asian Pac J Cancer Prev 2009; 10 (03) 335-338
  • 24 Gómez F, Casitas R, García M. Implementation of an inquiry quick diagnosis protocolized lung cancer. Arch Bronconeumol 2006; 42: 80