How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States

SIMPLE SUMMARY: Lung cancer is the most common cause of cancer related death in the US, but survival is far better when people are diagnosed at an earlier stage. There are currently no clinical quality measures that are routinely used to measure the quality or timeliness of diagnosis of lung cancer in the US. We used Natural Language Processing (NLP) to extract information on the symptoms and signs that had been recorded in the electronic medical records of patients presenting in ambulatory care over the 2 years prior to their diagnosis with lung cancer. We found that the time from the first recorded symptoms/signs associated with lung cancer to diagnosis was 570 days. The time intervals from chest CT or chest X-ray imaging to diagnosis, and from specialist consultation to diagnosis were shorter—at 43 and 72 days, respectively. Advanced techniques such as NLP can be used to extract detailed information from electronic medical records, that could potentially be used to create clinical quality measures with the goal of improving the timeliness of diagnosis of this cancer. ABSTRACT: The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012–2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273–691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11–240), specialist consultation to diagnosis 72 days (IQR 13–456), and from diagnosis to treatment initiation 7 days (IQR 0–36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.