Fifty-three studies were included in the review (n=33,410): 49 studies of timeliness; 14 studies of predictors of timely care; 18 studies of the association between outcomes and timely care; and eight studies of interventions aimed at improving timeliness. Validity assessment indicated that quality was generally lacking in the included studies. The main quality issues highlighted were small sample sizes, retrospective data collection and a lack of detail about the statistical analyses.
Most studies demonstrated that adherence with the guidelines for timeliness of lung cancer care was mediocre and many patients waited longer than the recommended waiting times. Factors associated with less timely care included teaching hospital setting, receipt of curative radiotherapy, requirement for multiple diagnostic tests, care received at more than one medical facility, atypical symptoms, comorbid conditions and initial referral to a non-respiratory physician.
Eighteen studies showed mixed effects of timeliness on survival and stage of cancer. Eight studies of interventions to improve timeliness showed mixed results.