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Theses and Dissertations

Waiting Time Intervals for Non-Small Cell Lung Cancer Diagnosis and Treatment in Alberta: Quantification of Intervals and Identification of Risk Factors Associated with Delays Open Access


Other title
System Interval
Waiting Times
Diagnostic Interval
Risk Factors
Treatment Interval
Non-Small Cell Lung Cancer
Type of item
Degree grantor
University of Alberta
Author or creator
Kim, Julian O.A.
Supervisor and department
Davis, Faith (School of Public Health)
Winget, Marcy (School of Public Health)
Examining committee member and department
Butts, Charles (Oncology)
Davis, Faith (School of Public Health)
Winget, Marcy (School of Public Health)
Yuan, Yan (School of Public Health)
Department of Public Health Sciences
Clinical Epidemiology
Date accepted
Graduation date
Master of Science
Degree level
Background: Very little is known regarding the time required to diagnose and treat patients with Non-Small Cell Lung Cancer (NSCLC) in Canada. Prompt diagnosis and treatment is critical for optimizing the quality and effectiveness of NSCLC care. Purpose: To quantify the duration of diagnostic and treatment intervals for NSCLC care in Alberta and identify risk factors associated with delayed diagnosis and treatment. Methods: The Alberta Cancer Registry was used to identify all cases of pathologically confirmed, stage I to III NSCLC diagnosed and treated in Alberta, Canada from 2004 to 2011. Diagnostic data were obtained from provincial physician billing and inpatient/outpatient hospital data. Missing data were obtained manually from electronic medical records. Data from all sources were linked to quantify the duration of the diagnostic and treatment intervals and their sum (system interval). Multivariable logistic regression was performed in order to identify which patient, disease, and treatment factors were independently associated with diagnostic or treatment delays. Results: 3009 eligible patients were included in the study; the median and 90th percentile system interval was 78 (95% CI 76-80) and 185 days (95% CI 178 to 195), respectively. Overall, the treatment interval was longer than the diagnostic interval, with median of 51 (95% CI 49-53) and 38 (95% CI 36-40) days, respectively. After multivariable adjustment, age above 60, and treatment with modalities other than supportive care, especially surgery (OR for treatment delay = 5.23, p<0.0001) were associated with delays. Factors associated with prompt care included high acuity presentations (OR for delayed diagnosis = 0.34, p<0.0001), and stage III disease (OR for delayed treatment = 0.38, p<0.0001). Conclusion: Over 50% of Albertans with potentially curable NSCLC experienced considerably long diagnostic and/or treatment intervals. Factors influencing the probability of delay in decreasing order of importance were: first treatment modality, acuity level of presentation, stage, and age. The results of this study suggest that care intervals could be shortened for NSCLC patients through the use of streamlined coordination of care, especially for those who require surgery.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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