Date and Time
November 12, 2008
1:30 PM - 3:00 PM

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Open to the public
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Few studies have examined timeliness of lung cancer care within the U.S. No studies to date have examined whether institutional characteristics (structures and processes of care) are associated with more or less timely care in patients with lung cancer. We used data from a VA nation-wide retrospective chart review and an independent audit of VA cancer programs to examine the association between time to first treatment and potentially explanatory institutional characteristics (e.g. volume of lung cancer patients) for 2,372 veterans diagnosed with lung cancer between 1/1/02 and 9/1/05 at 127 VA medical centers. We developed linear mixed effects models to control for clustering of patients within hospitals and stratified analyses by stage. We found that time to treatment varied widely and was often longer than recommended by recent guidelines. Time to treatment was longer in patients with limited (stage I and II) disease, and institutional factors associated with timeliness differed for patients with limited versus more advanced disease. In patients with limited stage disease, factors associated with shorter times to treatment included a non-academic setting and the existence of a specialized diagnostic clinic. In patients with more advanced disease, time to treatment was shorter at facilities that performed a patient flow analysis. In both groups, leadership beliefs about providing timely care were associated with shorter times to treatment. We conclude that time to lung cancer treatment in U.S. veterans is highly variable. The numerous institutional characteristics we examined explained relatively little of this variability, suggesting that patient, clinician, and/or unmeasured institutional characteristics may be more important determinants of timely care.