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Increasing Time-to-treatment For Resectable Non Small Cell Lung Cancer: Are We Going Back?
Manzar Abbas, Dean Tan, Jeffrey Luo, Kostantinos Poulikidis, M. Jawad Latif, Faiz Y. Bhora.
Hackensack Meridian JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA.
BACKGROUND: This study aims to identify predictors of prolonged time-to-treatment initiation (TTI) among patients undergoing lung cancer surgery using the National Cancer Database (NCDB, 2018-2022), and to determine whether increasing treatment delays correspond to survival differences across diagnosis years.
METHODS: We performed a retrospective cohort study of the stage I-IV (AJCC 8th edition) NSCLC cases in the NCDB. Patients with missing stage, treatment, or TTI data were excluded. TTI was defined as time from the radiological diagnosis to initiation of any treatment modality (surgery or systemic therapy). It was capped at 180 days to minimize outlier bias. Multivariable accelerated failure time (Gamma Regression) models were used to identify predictors of treatment delay; survival analysis for stage I-II was stratified by TTI ≤ 30, 31-60, and > 60 days.
RESULTS: Among eligible patients, mean TTI increased from 42 days (median 35) in 2018 to 53 days (median 44) in 2022. For stage I disease, Black patients experienced a 13% longer delay compared with White patients (TR = 1.13; 95% CI 1.11-1.14). Insurance status showed a strong gradient: Medicaid (TR = 1.22; 95% CI 1.19-1.24), government (TR = 1.28; 95% CI 1.24-1.31), and uninsured (TR = 1.21; 95% CI 1.16-1.27) were associated with significantly longer TTI versus private insurance. Treatment at different facilities added 14% additional delay (TR = 1.14; 95% CI 1.13-1.15). Male sex, higher comorbidity burden, community hospital setting, and later diagnosis year were also linked to modestly longer delays.In stage I-II disease, treatment initiation within 30 days demonstrated significantly superior overall survival compared with those treated after 60 days (p < 0.001) (Figure).
CONCLUSIONS: TTI for early-stage NSCLC has progressively lengthened in recent years, disproportionately affecting the Black and publicly insured patients and those treated across multiple facilities. These delays correlate with worse survival, underscoring the urgent need for system-level interventions addressing insurance disparities, care coordination, and timely access. This makes prompt treatment not only a clinical imperative but also a matter of inclusive healthcare.
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