Journal
CLINICAL LUNG CANCER
Volume 22, Issue 1, Pages E84-E97Publisher
CIG MEDIA GROUP, LP
DOI: 10.1016/j.cllc.2020.09.004
Keywords
Delay of care; Delayed treatment; Lung cancer; NCDB; Non-small cell lung cancer
Categories
Ask authors/readers for more resources
The study aimed to investigate the impact of time from diagnosis to initial treatment on survival in patients with non-small cell lung cancer. Delayed treatment was associated with poorer survival outcomes and disparities based on race, ethnicity, and socioeconomic status in non-metastatic non-small cell lung cancer.
The purpose of our study is to determine the effect of the interval from diagnosis to initial treatment on survival in patients with non-metastatic non small-cell lung cancer. A retrospective analysis of 140,555 patients from the National Cancer Database was performed; increased time from diagnosis to treatment initiation was independently associated with poorer survival and racial, ethnic, and socioeconomic disparities in non-metastatic non-small-cell lung cancer. This data helps to establish much needed context to develop future studies analyzing patterns of care and effects of delayed treatment. Background: The purpose of this study was to determine the effects of time from diagnosis to treatment (TTI) on survival in patients with nonmetastatic non-small-cell lung cancer (NSCLC). Materials and Methods: The National Cancer Database was queried for patients with stages 1 to 3 NSCLC between 2004 and 2013. Patients with missing survival status/time, unknown TTI, or receipt of palliative therapy were excluded. Multivariable Cox proportional hazards modeling, logistic regression, and recursive partitioning analysis were performed to determine associated variables and survival outcomes. Results: Altogether, 1,393,232 patients met inclusion criteria. The median follow-up was 36 months. The median TTI increased between 2004 and 2013 from 35 to 39 days (P < .001). On multivariable Cox proportional hazards modeling, TTI groups 31 to 60 days, 61 to 90 days, and > 90 days were independently related to poorer overall survival (OS) compared with TTI 1 to 30 days (hazard ratio, 1.04, 1.10, and 1.14; 95% confidence interval [CI], 1.02-1.06, 1.07-1.12, and 1.11-1.17, respectively; P < .001 for all). Recursive partitioning analysis revealed that TTI of <= 45 days was the most optimal threshold for survival (P < .001); patients with TTI <= 45 days had a median OS of 70.2 months (95% CI, 69.3-71.1 months) versus 61.5 months (95% CI, 60.5-62.4) (P < .001). There were significant disparities by age, race, ethnicity, and income for delayed (> 45 days) TTI (P <.001 for all). Subgroup analysis revealed that stage 1 and 2 patients with TTI > 45 days had a higher risk of mortality compared with TTI <= 45 days (hazard ratio, 1.15 and 1.05; 95% CI, 1.12-1.17 and 1.01-1.09, respectively) (P < .001). Conclusions: Increased TTI is independently associated with poorer survival in non-metastatic NSCLC. TTI <= 45 days is a clinically targetable time frame associated with improved outcomes and ought to be considered for patients with lung cancer undergoing definitive therapy. (C) 2020 Elsevier Inc. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available