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Print version ISSN 0102-3586On-line version ISSN 1678-4642
J. Pneumologia vol.29 no.6 São Paulo Nov./Dec. 2003
Haste may not make waste
Department of Thorax Hospital do Câncer - Center for Diagnosis and Treatment São Paulo, SP
The earlier the treatment, the greater are the chances of cure or disease control. The earlier the diagnosis, the speedier treatment will begin. Those are two well known truths put into practice whenever possible.
For a disease that presents actuarial data of 14% of 5 years survival 1 in the USA and a survival of 28% in highly specialized centers that care for selected patients after diagnosis2, such statements are truer than ever
In this issue of the Journal of Pulmonology, Knorst and collaborators 3 provide an important picture of why these truths do not hold in Brazil. The authors have identified an average delay of 140 days until diagnosis of lung cancer encompassing time since onset of symptoms, visiting the physician and from thereon to final diagnosis. This data was obtained by a retrospective study of patients submitted to surgery with curative intent at a General University Hospital. Depending on where diagnosis took place, in the case of this population, the authors noted that diagnosis was significantly more delayed for outpatients with a median of time twice that of the inpatients.
Compared to the European series that point towards means of 200 days 4 , such figures may appear better. However, this is not so. In a previous series in our country, Silva and collaborators did not describe the mean of time, but the median is of almost 120 days 5. In this latter study are included patients with a non surgical diagnosis. The above and the study in the current issue of the Journal of Pulmonology outline a profile of the decade of the nineties in Brazil and show a result that can and must be improved.
It was recently suggested that, as a goal, delays for treatment of lung cancer should not exceed a total time of about 90 days from diagnosis to treatment. That is to say, one week for consultation with the specialist, 2 weeks for the diagnostic essays, when required chemotherapy should start in seven days, radiotherapy in two days and surgery in no more than 4 to 8 weeks 6.
The study in this issue of the Journal of Pulmonology further points out a question of major concern: the fact that diagnosis of inpatients is more agile disavows worldwide tendencies.
Urgent measures should be taken to revert this scenario. After such an accurate diagnosis of the stages in which time is lost and of how much time is lost at each stage, Knorst and collaborators have triggered the process. This information is fundamental for the planning of what has to be done. Time for diagnosis is over.
1. Parkin DM, Pisani P, Serlay J. Global cancer statistics. CA Cancer J Clin 1999;49:33-64.
2. Younes RN. Câncer de pulmão: prevenção, diagnóstico e tratamento. Experiência de tratamento Hospital do Câncer AC Camargo, 2001.
3. Knorst MM, Dienstmann R, Fagundes LP. Retardo no diagnóstico e no tratamento cirúrgico do câncer de pulmão. J Pneumol 2003;29:358-64.
4. Koyi H, Hillerdal G, Branden E. Patient's and doctors' delay in the diagnosis of chest tumors. Lung Cancer 2002;35:53-7.
5. Silva PA, Pereira JR, Ifari FK, Minamoto H. Câncer de pulmão e retardo no diagnóstico: análise de 300 casos. Rev Assoc Med Bras 1992; 38:145-9.
6. Alberts WM, Bepler G, Hazelton T, Ruckdeschel JC, Williams Jr JH. Practice organization. Chest 2003;123:332-7.