Narrowing the Gap: Understanding Lung Cancer Care Intervals and Their Barriers in Latin American Low and Middle-Income Countries

Abstract

Background and Aims

Barriers in lung cancer (LC) management impact patient care and their outcomes, yet studies from high-income countries may not be fully applicable to low- and middle-income countries (LMICs) with distinct healthcare challenges. This study aims to characterize LC care intervals and their barriers in a Latin American LMIC.

Methods

This analysis of patients with LC diagnosed between 2003 and 2016 at a national cancer referral center, calculated the duration of the following six intervals: from symptom onset to first specialist visit (StFS), first specialist visit to diagnosis (FStDX), diagnosis to treatment initiation (DXtTX), symptom onset to diagnosis (StDX), first specialist visit to treatment (FStTX), and symptom onset to treatment (StTX). Clinicopathological and sociodemographic characteristics were extracted from electronic medical records. Multivariate Cox regression was used to identify factors associated with the duration of each care interval.

Results

503 patients were included; the majority were females (52.7%), with adenocarcinoma (76%) and a positive smoking status (56%). The median duration in days (interquartile range [IQR]) of StFS, FStDX, DXtTX, StDX, FStTX, and StTX were 90 (142), 34 (63), 17 (25), 148 (149), 60 (79), and 173 (153), respectively. In multivariate analyses, factors associated with the length of care intervals were sex, marital status, disease stage, mutational status, asbestos, and wood smoke exposure. After adjustment, sex remained a statistically significant predictor of longer intervals.

Conclusion

Our findings support the identification of barriers and the development of interventions aimed at shortening LC care intervals, particularly among disadvantaged individuals who are more likely to experience delays.