The road to diagnosis and treatment of patients with lung cancer

Abstract

Lung cancer is the third most common cancer among men and women in Sweden. More than 3000 persons/year are diagnosed with lung cancer. Despite the presence of many and intense symptoms at diagnosis, most patients still receive the diagnosis in advanced stages without possibility of resection. It is therefore important to obtain more knowledge, from different perspectives, about underlying factors leading to delay in the care trajectory to diagnosis and treatment start.

The overall aim for this thesis is to obtain more knowledge about factors which may delay diagnosis and treatment start in lung cancer through - exploring the length of different time spans from first symptom to treatment" Start, and relationships between reported symptoms, demographic and medical characteristics and these time spans (Study I) - exploring how patients with lung cancer conceptualise the onset of sickness (Study II).

As a variety of factors related to patients, providers and the health care system can contribute to delay in diagnosis and treatment, medical records were examined from 314 patients diagnosed with primary lung cancer at a specialist clinic. Analyses included cluster analyses, descriptive analyses and Cox's regression.

The results show that tumor-specific symptoms led to health care system visits to a greater extent than systemic symptoms did, despite reports of weight loss, fatigue and appetite loss as common first symptoms. Elderly people (>75 years) risked longer time spans between first health care system visit and specialist referral and treatment start in comparison to other age groups. Age <60 years was associated with a shorter time span from first health care visit to treatment start. People living alone risked extended time from specialist referral to diagnosis.

Studies about delay in lung cancer are predominantly based on data from medical records And present as is in study I, in terms of number of days between different key events in the care pathway. In order to complement previous studies, audio-taped semi-structured explorative interviews from 41 patients were analysed. Findings are based on retrospective narratives one year after diagnosis. However, many participants spontaneously reflected over possible causes for their disease with reference to their biographies.

The onset of lung cancer often integrated of past and present aspects of patients' lives in a type of "biographical continuity", which is in contrast to the biographical disruption often described in relation to cancer diagnosis. Findings also indicate a wide array of bodily experiences leading to diagnosis, including symptoms seen as related to other disorders, systemic complaints not conceptualised as symptoms or as indicating a serious problem, and more rarely, symptoms triggering immediate action.