Table 1 Characteristics of included studies

Abrao, F. C. and 2017 [33]

Brazil

To evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment.

Retrospective study

62.50 years

57.8%

42.2%

Long waiting times and health system’s incapacity to absorb all patients.

Diagnosis is faster when the patient can make an appointment with a specialist

Chandra, Subhash and 2009 [34]

India

To determine the average time period required at various steps for diagnosing lung cancer from the onset of symptoms at a tertiary referral centre in Northern India

Retrospective study

53 years and older

84.2%

15.8%

High cost and inaccessibility of diagnostic investigations such as CT scan, chemotherapy, broncoscopy and long waiting periods

Inappropriate treatment with ATT significantly prolongs delay

Chatterjee, Surajit and 2016 [35]

India

To summarize the contributing factors in delaying diagnosis of lung cancer for our better knowledge.

Observational cross-sectional

55.50 years

72.0%

28.0%

High cost and limited availability of CT thorax and long waiting times

Patients were not advised on CT thorax at appropriate time and instead received ATT causing referral delay

Fernandez de la Vega, J. F. and 2015 [35]

Cuba

To Assess diagnostic delay of lung cancer in patients at the Joaquín Albarrán Clinical-Surgical Teaching Hospital, Havana, Cuba, from 2007 to 2010.

Retrospective study

51–60 years

74.1%

25.9%

Lack of diagnostic tools for imaging, endoscopy and pathology, lack of suitable lung cancer protocol, poor organization and management of health services.

Patients who went directly to hospital did not benefit from shorter delay in diagnosis

Hsieh, Vivian Chia-Rong and 2012 [25]

Taiwan

To understand the delay in the diagnosis of lung cancer under the healthcare system in Taiwan, and to identify the factors associated with it.

Descriptive analysis

62.68 years

55.9%

44.1%

Misinterpretation of a chest CT scan, high cost of CT scan and delays due to multiple medical visits.

Delays increase as number of doctors or visits increase

Ramachandran, Krishnappriya and 2016 [40]

India

To assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center.

Prospective study

Not specified

Not specified

Not specified

Lung cancer was misdiagnosed as TB and treated with ATT, inadequacy of medical services, delay in referrals and in the performance of subsidiary tests.

Many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis

Sulu, E. and 2011 [36]

Turkey

To investigate patterns of delays among patients with non-small-cell lung cancer and to identify reasons for the delays.

Prospective study

60.6 years

90.1%

9.9%

Low index of suspicion for lung cancer, organizational problems, long waiting lists for radiotherapy and surgery, low performance of diagnostic methods and limited

Prehospital delays are largely dependent on the level of patient education and complex socioeconomic factors.

Valdes, S. and 2010 [37]

Cuba

To identify the length of diagnostic delay in a group of patients diagnosed with non-small cell lung cancer by determining the time elapsed from onset of symptoms to confirmation of diagnosis.

Descriptive observational study

32–88 years

69.0%

31.0%

Delays in obtaining results of CT tests, low index of suspicion for lung cancer and unavailability of diagnostic tools.

The length of health system-attributed diagnostic delay was prolonged and in need of improvement.

Yurdakul, Ahmet Selim and 2015 [38]

Turkey

To investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays.

Prospective study

61.5 years

91.0%

8.9%

Physician’s opinion of another diagnosis, delays in pathologic/radiologic/bronchoscopic examination, patient refusal to undergo procedure, a large volume of patients/lack of bed and long waiting time for hospitalisation.

Diagnostic and treatment delays were longer in early-stage cases.

Zivkovic, D. and 2014 [39]

Montenegro

To investigate whether waiting times and delays in diagnosis and treatment of patients with lung carcinoma have any bearing on prognosis and survival.

Retrospective study

66 years

83.0%

17.0%

Specialist services delay.

No significant difference in survival between patients with stage I and stage II NSCLC according to delay from the onset of first symptoms.