{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:21:06Z","timestamp":1793715666914,"version":"4.6.1"},"reference-count":29,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:00:00Z","timestamp":1619049600000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C8640\/A23385"],"award-info":[{"award-number":["C8640\/A23385"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,2,28]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the \u2018patient interval\u2019, individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the \u2018primary care interval\u2019, doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the \u2018secondary care interval\u2019, obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045056","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T12:24:11Z","timestamp":1619094251000},"page":"e045056","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4160-0550","authenticated-orcid":false,"given":"Morhaf","family":"Al Achkar","sequence":"first","affiliation":[{"name":"Department of Family Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7007-6973","authenticated-orcid":false,"given":"Monica","family":"Zigman Suchsland","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7191-6476","authenticated-orcid":false,"given":"Fiona M","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3544-2744","authenticated-orcid":false,"given":"Richard D","family":"Neal","sequence":"additional","affiliation":[{"name":"University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo H L","family":"Goulart","sequence":"additional","affiliation":[{"name":"Food and Drug Adminstration, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"key":"2025101814294992000_11.4.e045056.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21387"},{"key":"2025101814294992000_11.4.e045056.2","unstructured":"Center for Disease Control and Prevention . Leading cancer cases and deaths, all Races\/Ethnicities, male and female, 2017. Available: https:\/\/gis.cdc.gov\/Cancer\/USCS\/DataViz.html [Accessed 20 Jun 2020]."},{"key":"2025101814294992000_11.4.e045056.3","first-page":"250","article-title":"Lung cancer: diagnosis, treatment principles, and screening","volume":"91","author":"Latimer","year":"2015","journal-title":"Am Fam Physician"},{"key":"2025101814294992000_11.4.e045056.4","article-title":"The role of social context in symptom appraisal and help-seeking among people with lung or colorectal symptoms: a qualitative interview study","volume":"27","author":"Dobson","year":"2018","journal-title":"Eur J Cancer Care"},{"key":"2025101814294992000_11.4.e045056.5","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmv048"},{"key":"2025101814294992000_11.4.e045056.6","doi-asserted-by":"publisher","DOI":"10.1017\/S1463423614000516"},{"key":"2025101814294992000_11.4.e045056.7","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.30"},{"key":"2025101814294992000_11.4.e045056.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2017.08.011"},{"key":"2025101814294992000_11.4.e045056.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2015.09.009"},{"key":"2025101814294992000_11.4.e045056.10","doi-asserted-by":"publisher","DOI":"10.1111\/crj.12217"},{"key":"2025101814294992000_11.4.e045056.11","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.109330"},{"key":"2025101814294992000_11.4.e045056.12","unstructured":"Lovly C , Horn L , Pao W . 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