Treatment delay in lung cancer
Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival

https://doi.org/10.1016/j.radonc.2015.04.010Get rights and content

Abstract

Purpose

Prompt staging and treatment are crucial for non-small cell lung cancer (NSCLC). We determined if predictors of treatment delay after diagnosis were associated with prognosis.

Materials and methods

Medicare claims from 28,732 patients diagnosed with NSCLC in 2004–2007 were used to establish the diagnosis-to-treatment interval (ideally ⩽35 days) and identify staging studies during that interval. Factors associated with delay were identified with multivariate logistic regression, and associations between delay and survival by stage were tested with Cox proportional hazard regression.

Results

Median diagnosis-to-treatment interval was 27 days. Receipt of PET was associated with delays (57.4% of patients with PET delayed [n = 6646/11,583] versus 22.8% of those without [n = 3908/17,149]; adjusted OR = 4.48, 95% CI 4.23–4.74, p < 0.001). Median diagnosis-to-PET interval was 15 days; PET-to-clinic, 5 days; and clinic-to-treatment, 12 days. Diagnosis-to-treatment intervals <35 days were associated with improved survival for patients with localized disease and those with distant disease surviving ⩾1 year but not for patients with distant disease surviving <1 year.

Conclusion

Delays between diagnosing and treating NSCLC are common and associated with use of PET for staging. Reducing time to treatment may improve survival for patients with manageable disease at diagnosis.

Section snippets

Materials and methods

This study was granted exempt status by The University of Texas MD Anderson Cancer Center’s institutional review board. Patients were selected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare and Texas Cancer Registry (TCR)-Medicare databases, which collectively report data on incident malignancies diagnosed in patients residing in 17 geographic catchments representing approximately 34% of the US population. The patient population consisted of 28,732 patients and is further

Results

Of 28,732 patients, 27.7% had local, 31.2% regional, and 41.1% distant disease. Other patient characteristics are listed in Table 1. The incidence of PET according to SEER stage was 38.9% for those with localized disease (n = 3069/7960), 46.4% for regional (n = 4158/8962), and 36.9% for distant (n = 4356/11,810). The median time from diagnosis to treatment was 27 days, and 36.7% of patients (n = 10,554) experienced delay between diagnosis and treatment. Both staging studies and other study covariates

Discussion

In this population-based analysis of the effect of disease-staging studies on delays in beginning treatment for newly diagnosed NSCLC, our pertinent findings are as follows. First, almost 40% of patients had substantial treatment delays after the diagnosis of lung cancer. Second, delays in treatment were correlated with changes in survival, with this association being stage dependent. Finally, the cause of delays was multifactorial and related to several staging studies obtained after diagnosis

Conflict of interest statement

The authors have no conflicts of interest to declare.

Funding sources and acknowledgments

Supported in part by Cancer Center Support (Core) Grant CA016672 to The University of Texas MD Anderson Cancer Center and the Center for Radiation Oncology Research. Drs. Gomez, Smith, and Giordano are supported by the Cancer Prevention and Research Institute of Texas’s Comparative Effectiveness Research in Texas (RP101207). Dr. Giordano is also supported by American Cancer Society 117488-RSGI-09-149-01-CPHPS. The authors sincerely thank Christine Wogan, M.S., E.L.S., of MD Anderson’s Division

References (22)

  • M. Ouwens et al.

    Development of indicators for patient-centred cancer care

    Suppor Care Cancer

    (2010)
  • Cited by (0)

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