Original Article

Small Cell Lung Cancer: Time to Diagnosis and Treatment

Authors: Niaz Haque, MD, Amer Raza, MD, Robin McGoey, MD, Brian Boulmay, MD, Lisa Diethelm, MD, Stephen Kantrow, MD

Abstract

Objectives: Small cell lung cancer (SCLC) is the most rapidly progressive form of lung cancer, and delays in treatment may increase the tumor burden. We determined the time from abnormal radiograph to diagnosis and treatment for patients with SCLC and investigated the effect of emergent presentation, stage, radiographic findings, and race on these measures and survival.


Methods: Retrospective analysis of clinical data for 45 consecutive evaluable patients at a single institution diagnosed as having SCLC.


Results: Median time from first abnormal radiograph to tissue diagnosis was 10 days and time from first abnormal radiograph to initiation of treatment was 35 days. Emergency department presentation led to earlier diagnosis compared with the clinic (3 vs 21 days), with a trend toward earlier treatment (15 vs 39 days; P = 0.057). No significant effect of radiographic findings, disease stage, or race was observed from time to diagnosis or treatment. Forty-three patients (96%) died, with a median survival time from initial abnormal radiograph to death of 375 days. Survival was longer for patients with limited stage disease (619 vs 230 days), but it was not significantly affected by emergent presentation, radiographic findings, or race. Consistent with the aggressive behavior of SCLC, 10 patients (22%) had a normal radiograph within 6 months prediagnosis, and 7 of these had extensive disease.


Conclusions: The median time from abnormal radiograph to initiation of treatment for SCLC in our single-center study overlapped with the expected doubling time for this malignancy and likely allowed a preventable increase in tumor burden.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Arai T, Kuroishi T, Saito Y, et al. Tumor doubling time and prognosis in lung cancer patients: evaluation from chest films and clinical follow-up study. Japanese Lung Cancer Screening Research Group. Jpn J Clin Oncol 1994; 24: 199–204.
 
2. Sone S, Nakayama T, Honda T, et al. CT findings of early-stage small cell lung cancer in a low-dose CT screening programme. Lung Cancer 2007; 56: 207–215.
 
3. Simon GR, Wagner H. Small cell lung cancer. Chest 2003; 123: 259S–271S.
 
4. Asch SM, Kerr EA, Hamilton EG, et al. Quality of Care for Oncologic Conditions and HIV. Santa Monica, CA, RAND Health, 2000, 133–164.
 
5. Whitley NO, Fuks JZ, McCrea ES, et al. Computed tomography of the chest in small cell lung cancer: potential new prognostic signs. AJR Am J Roentgenol 1984; 142: 885–892.
 
6. Muggia FM, Krezoski SK, Hansen HH. Cell kinetic studies in patients with small cell carcinoma of the lung. Cancer 1974; 34: 1683–1690.
 
7. Tinnemans MM, Schutte B, Lenders MH, et al. Cytokinetic analysis of lung cancer by in vivo bromodeoxyuridine labelling. Br J Cancer 1993; 67: 1217–1222.
 
8. Vescio RA, Connors KM, Bordin GM, et al. The distinction of small cell and non-small cell lung cancer by growth in native-state histoculture. Cancer Res 1990; 50: 6095–6099.
 
9. Christensen JA, Bressler L, Bath K, et al. Rapid tumor doubling in the CNS. J Neurooncol 2008; 87: 119–121.
 
10. Kim MY, Oskarsson T, Acharyya S, et al. Tumor self-seeding by circulating cancer cells. Cell 2009; 139: 1315–1326.
 
11. Watson WL, Berg JW. Oat cell lung cancer. Cancer 1962; 15: 759–768.
 
12. Pearlberg JL, Sandler MA, Lewis JW Jr, et al. Small-cell bronchogenic carcinoma: CT evaluation. AJR Am J Roentgenol 1988; 150: 265–268.
 
13. Kazawa N, Kitaichi M, Hiraoka M, et al. Small cell lung carcinoma: eight types of extension and spread on computed tomography. J Comput Assist Tomogr 2006; 30: 653–661.
 
14. Swensen SJ, Silverstein MD, Ilstrup DM, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med 1997; 157: 849–855.
 
15. Meniga IN, Tiljak MK, Ivankovic D, et al. Prognostic value of computed tomography morphologic characteristics in stage I non-small-cell lung cancer. Clin Lung Cancer 2010; 11: 98–104.
 
16. Titulaer MJ, Soffietti R, Dalmau J, et al. Screening for tumours in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol 2011; 18: 19–e13.
 
17. Berthelet E, Truong PT, Lesperance M, et al. Examining time intervals between diagnosis and treatment in the management of patients with limited stage small cell lung cancer. Am J Clin Oncol 2006; 29: 21–26.
 
18. Schultz EM, Powell AA, McMillan A, et al. Hospital characteristics associated with timeliness of care in veterans with lung cancer. Am J Respir Crit Care Med 2009; 179: 595–600.
 
19. Gonzalez JM, de Castro FJ, Barrueco M, et al. Delays in the diagnosis of lung cancer. Arch Bronconeumol 2003; 39: 437–441.
 
20. Gould MK, Ghaus SJ, Olsson JK, et al. Timeliness of care in veterans with non-small cell lung cancer. Chest 2008; 133: 1167–1173.
 
21. Murai T, Shibamoto Y, Baba F, et al. Progression of non-small-cell lung cancer during the interval before stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2012; 82: 463–467.
 
22. Mohammed N, Kestin LL, Grills IS, et al. Rapid disease progression with delay in treatment of non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2011; 79: 466–472.
 
23. Riedel RF, Wang X, McCormack M, et al. Impact of a multidisciplinary thoracic oncology clinic on the timeliness of care. J Thorac Oncol 2006; 1: 692–696.
 
24. Blackstock AW, Herndon JE 2nd, Paskett ED, et al. Outcomes among African-American/non-African-American patients with advanced non-small-cell lung carcinoma: report from the Cancer and Leukemia Group B. J Natl Cancer Inst 2002; 94: 284–290.
 
25. Bryant AS, Cerfolio RJ. Impact of race on outcomes of patients with non-small cell lung cancer. J Thorac Oncol 2008; 3: 711–715.
 
26. Blackstock AW, Herndon JE 2nd, Paskett ED, et al. Similar outcomes between African American and non-African American patients with extensive-stage small-cell lung carcinoma: report from the Cancer and Leukemia Group B. J Clin Oncol 2006; 24: 407–412.
 
27. Albain KS, Unger JM, Crowley JJ, et al. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst 2009; 101: 984–992.
 
28. Lim E, Belcher E, Yap YK, et al. The role of surgery in the treatment of limited disease small cell lung cancer: time to reevaluate. J Thorac Oncol 2008; 3: 1267–1271.