Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study
Background Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.Purpose We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutat...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/4/e045056.full |
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| author | Fiona M Walter Morhaf Al Achkar Monica Zigman Suchsland Matthew J Thompson Bernardo H L Goulart |
| author_facet | Fiona M Walter Morhaf Al Achkar Monica Zigman Suchsland Matthew J Thompson Bernardo H L Goulart |
| author_sort | Fiona M Walter |
| collection | DOAJ |
| description | Background Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.Purpose We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.Methods Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.Results 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the ‘patient interval’, individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the ‘primary care interval’, doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the ‘secondary care interval’, obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.Conclusions Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection. |
| format | Article |
| id | doaj-art-71fdf1c77d1f4b00958f9b70ffcffe9a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-71fdf1c77d1f4b00958f9b70ffcffe9a2024-11-21T17:55:09ZengBMJ Publishing GroupBMJ Open2044-60552021-04-0111410.1136/bmjopen-2020-045056Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative studyFiona M Walter0Morhaf Al Achkar1Monica Zigman Suchsland2Matthew J Thompson3Bernardo H L Goulart44 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UKDepartment of Family Medicine, University of Washington, Seattle, Washington, USAUniversity of Washington, Seattle, Washington, USA1 Department of Family Medicine, University of Washington, Seattle, Washington, USAFood and Drug Adminstration, Washington, DC, USABackground Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.Purpose We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.Methods Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.Results 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the ‘patient interval’, individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the ‘primary care interval’, doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the ‘secondary care interval’, obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.Conclusions Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.https://bmjopen.bmj.com/content/11/4/e045056.full |
| spellingShingle | Fiona M Walter Morhaf Al Achkar Monica Zigman Suchsland Matthew J Thompson Bernardo H L Goulart Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study BMJ Open |
| title | Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study |
| title_full | Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study |
| title_fullStr | Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study |
| title_full_unstemmed | Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study |
| title_short | Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study |
| title_sort | experiences along the diagnostic pathway for patients with advanced lung cancer in the usa a qualitative study |
| url | https://bmjopen.bmj.com/content/11/4/e045056.full |
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