MedicalResearch.com Interview with:
Raymond Osarogiagbon MD, FACP
Thoracic Oncology Research Group
Baptist Cancer Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Osarogiagbon: Lung cancer care is complicated, but can be broken down into 5 steps: x-ray detection, biopsy, x-ray tests of cancer spread (the ‘stage’), biopsy of suspicious areas where cancer may have spread, and treatment.
Looking only at patients who had surgery for a suspected lung cancer, we worked backwards to see how their care went through the key steps and how long it took.
We found that patients often skip some of the crucial steps. For example, 22% did not have a staging PET/CT scan, 88% did not have an invasive staging test. Only 10% had the recommended combination of 3 staging tests leading up to surgery: a CT scan, PET/CT scan, and invasive staging test.
It took a month and a half to more than 6 months for the middle half of patients to go from first abnormal x-ray sign of possible lung cancer to surgery.
Medical Research: What should clinicians and patients take away from your report?
Dr. Osarogiagbon: It takes too long for patients who may have lung cancer to get to final treatment (in this case, surgery) and too many patients skip vital steps needed to decide the best possible treatment. This leads to surgery in advanced cases where other treatment might have been more appropriate. We are also concerned that the reverse problem is probably also happening, where patients who might benefit from surgery do not get it.
Patients should ask lots of questions: ‘How long will it take to figure out what’s the best treatment for me?’, ‘what’s the stage of my cancer?’, ‘how do you know?’, ‘how do you know this is the best treatment for me?’
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Osarogiagbon: We have only looked at patients with the best possible outcomes: they received surgery. We don’t yet know how many patients who may have benefited from surgery missed the opportunity because of delays or misinterpretation of their test results. The current report came from an ongoing research project to test the value of changing the care delivery system to center lung cancer patients in the midst of key specialist doctors early in each patient’s care journey. We’re trying to test if this method increases the rate at which patients get the right care at the right time, and whether that improves patients’ care experience and survival.
More research is needed into the barriers to successful implementation of effective multidisciplinary care programs at all types of lung cancer care delivery environments (tertiary and community care centers). Otherwise recent, current and future advances in lung cancer treatment will not translate into meaningful change at the broad population level.
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Raymond Osarogiagbon MD, FACP (2015). Lung Cancer Diagnosis and Staging Takes Too Long In Real World Settings