The Effects of Time to Treatment Initiation for Patients With Non-small-cell Lung Cancer in the United States

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.

Automated summary

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.