Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant, Clinical Associate Professor Torben Riis Rasmussen, Aarhus University Hospital, Denmark
- Second opponent: Associate Professor Hanne Sorger, NTNU - Norwegian University of Science and Technology
- Third member and chair of the evaluation committee: Professor Knut Stavem, University of Oslo
Chair of the Defence
Professor Kristina Ingrid Helena Hermann Haugaa, University of Oslo
Principal Supervisor
Associate Professor Lars Fjellbirkeland, University of Oslo
Summary
Lung cancer is an aggressive disease with a poor prognosis, apparently worse in males than females. The diagnostic process is complex and time-consuming, and diagnostic delays can affect treatment possibilities and prognosis.
The aims of the thesis "Lung cancer; sex-related survival and optimising diagnostic pathways in a comprehensive population" were to explore which factors were associated with delays in the time from referral to treatment in non-small cell lung cancer and to evaluate the association of local and national initiatives on timeliness. In addition, the thesis examined the impact of sex on lung cancer-related survival. The study population was comprised of a cohort of patients diagnosed with lung cancer at Sørlandet Hospital Kristiansand in 2007-16.
Patients with limited, curable disease had significantly longer median time from referral to treatment (TTT) than patients diagnosed in advanced stages with 64 vs 28 days. Introducing logistic improvements reduced the median TTT by 11 days for all patients. Patients receiving curative intent treatment gained a reduction of three weeks.
Factors associated with delay included the number of diagnostic procedures, stage I-III versus stage IV and older age in both small and non-small cell lung cancer. Outpatient versus inpatient evaluation was associated with a delay in small cell lung cancer, while out-of-house procedures caused a delay in non-small cell lung cancer.
The five-year survival in the study population was 21,4% in men and 27,4% in women. However, after adjusting for known prognostic cofactors using restricted median survival time, the difference in survival was found to be a non-significant 0.9 months in favour of females. The main reason for the observed survival difference was due to women more often being diagnosed with less advanced cancer, still available for curative treatment.
Additional information
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