Delays for diagnosis and treatment of lung cancers: a systematic review.

BACKGROUND AND AIMS: The impact of diagnosis and treatment delays for non-small cell lung cancer management is poorly understood, even if the literature on the subject is currently increasing in importance. We have few indicators that can serve as reference for quality assurance actions. The objective of this review was to review the literature on the subject. METHODS: A literature search, using the words 'human lung cancer delay' and 'human lung cancer waiting time', was undertaken in Medline database. RESULTS: Several studies analyzed these delays mostly in a monocentric setting. There is an important variability in the definition of these delays, in the collection methods and in the results obtained. However, it seems distinctly clear that long delays are frequently observed in less symptomatic patients and, therefore, are accompanied by better prognosis. CONCLUSION: More standardized definitions and procedures to calculate time intervals between cancer diagnosis and treatment should be implemented to better understand the delays of lung cancer management.

6-Min walk-test data in severe obstructive-sleep-apnea-hypopnea-syndrome (OSAHS) under continuous-positive-airway-pressure (CPAP) treatment.

INTRODUCTION: Few studies have evaluated the functional capacity of severe OSAHS. AIMS: To assess their functional capacity, identify their 6-min walking-distance (6MWD) influencing factors and compare their data with those of two control-groups. METHODS: Sixty (42 males) clinically consecutive stable patients with severe OSAHS under CPAP were included. Clinical, Epworth questionnaire, anthropometric, polysomnographic, plethysmographic and 6-min walk-test (6MWT) data were collected. Univariate and multivariate analyses were used to identify the 6MWD influencing factors. Data of a subgroup of severe OSAHS aged ≥40 Yrs (n = 49) were compared with those of non-obese (n = 174) and obese (n = 55) groups. RESULTS: The means ± SD of age and apnea-hypopnea-index were, respectively, 49 ± 10 Yr and 62 ± 18/h. The profile of OSAHS patients carrying the 6MWT, was as follows: at the end of the 6MWT, 31% and 25% had, respectively, a high dyspnea (>5/10, visual analogue scale) and a low heart-rate (<60% of-maximal-predicted), 13% had an abnormal 6MWD ( 5 points and 3% stopped the walk. The factors that significantly influenced the 6MWD, explaining 80% of its variability, are included in the following equation: 6MWD (m) = 29.66 × first-second-forced-expiratory-volume (L) - 4.19 × Body-mass-index (kg/m(2)) - 51.89 × arterial-hypertension (0. No; 1. Yes) + 263.53 × Height (m) + 2.63 × average oxy-sat during sleep (%) - 51.06 × Diuretic-use (0. No; 1. Yes) - 20.68 × Dyspnea (NYHA) (0. No; 1. Yes) - 38.09 × Anemia (0. No; 1. Yes) + 5.79 × Resting oxy-sat (%) - 586.25. Compared with non-obese and obese groups, the subgroup of OSAHS has a significantly lower 6MWD [100 ± 9%, 100 ± 8% and 83 ± 12%, respectively). CONCLUSION: Severe OSAHS may play a role in reducing the functional capacity.