The time required to diagnose and treat lung cancer in Delhi, India: an updated experience of a public referral center

Background: Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients. Methods: A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test. Results: One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56­168] days to undergo a definitive diagnostic study, 107 [60­173] days to confirm a diagnosis, and 126 [85­196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134­261.5] days vs. 113 [75­180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened. Conclusion: Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.

Management of severe sepsis: role of "bundles".

Sepsis is the leading cause of hospital admissions, morbidity and mortality. Treating sepsis is expensive resulting in consumption of major health care resources. With development of newer and potent antimicrobial agents, moratlity due to sepsis has reduced markedly, but remains unacceptably high. Recently, various strategies like fluid therapy, low dose corticosteroids, tight glycaemic control, recombinant human activated protein C [(rhAPC), drotrecogin alfa] and lung protective ventilation have shown favourable results. Further, it is thought that combination of these strategies in the form of "bundles" can further improve the outcome. Concerted utilisation of the "sepsis bundles" is likely to improve outcome of this serious disorder.