Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer

Heiden, Brendan T.; Eaton, D.; Engelhardt, K; Chang, Su‐Hsin; Yan, Yan; Patel, Mayank R.; Kreisel, Daniel; Nava, Ruben G.; Meyers, Bryan F.; Kozower, Benjamin D.; Puri, Varun

doi:10.1001/jamanetworkopen.2021.11613

Cited by 75 publications

(78 citation statements)

References 34 publications

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“…Conversely, the time between preoperative diagnostic CT imaging and surgical treatment was reported to be associated with an increased risk of recurrence. 14 Patients who underwent surgical treatment within 12 weeks of diagnosis had better overall survival than those who underwent procedures that were delayed for more than 12 weeks. 14 The total of 123 days for pre-visit, pre-diagnosis, and pre-treatment times encountered by patients in our study undergoing surgery could increase the risk of recurrence or poor prognosis in the future.…”

Section: Discussionmentioning

confidence: 99%

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

et al. 2022

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Objective The impact of the coronavirus disease 2019 (COVID-19) pandemic on cancer care remains a concern. We aimed to evaluate access to diagnosis and treatment for lung cancer during the pandemic. Methods Times (days) from lung cancer symptom onset or referral to visit (pre-visit time), from visit to diagnosis (pre-diagnosis time), and from diagnosis to treatment (pre-treatment time) during the pandemic were compared with the times during the pre-pandemic period. Results The number of patients diagnosed with lung cancer was 82 and 75 during the pandemic and pre-pandemic periods, respectively. The percentage of patients with advanced-stage cancer was higher (65.9% vs. 46.7%), the percentage of patients treated with surgery was lower and the percentage treated with medication was higher (24.4% vs. 41.3% and 57.3% vs. 40.0%, respectively), the pre-visit time was longer (28.2 vs. 11.4 days), and the pre-treatment time for surgery was longer (67.3 vs. 45.6 days) during the pandemic compared with the times during the pre-pandemic period, respectively. Conclusions The COVID-19 pandemic resulted in delayed diagnoses, which could have led to patients being diagnosed with advanced disease. The pandemic also resulted in delayed therapy owing to the requirement for available intensive care unit beds for emergencies, including surgery.

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Section: Discussionmentioning

confidence: 99%

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

et al. 2022

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“…[3][4][5]7,12,13 Black patients with early-stage lung cancer are more likely to experience treatment delays 4,14,15 and have higher mortality rates than White patients. 4,6,7,14,[16][17][18][19][20][21] Black race is associated with lung cancer treatment delays averaging 6.7 days. 13 Factors contributing to delays in timely care include inadequate access to specialty care, poor care coordination, and poor patient-provider communication.…”

Section: Introductionmentioning

confidence: 99%

Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery

Charlot

Stein

Damone

et al. 2022

JCO

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PURPOSE Timely lung cancer surgery is a metric of high-quality cancer care and improves survival for early-stage non–small-cell lung cancer. Historically, Black patients experience longer delays to surgery than White patients and have lower survival rates. Antiracism interventions have shown benefits in reducing racial disparities in lung cancer treatment. METHODS We conducted a secondary analysis of Accountability for Cancer Care through Undoing Racism and Equity, an antiracism prospective pragmatic trial, at five cancer centers to assess the impact on overall timeliness of lung cancer surgery and racial disparities in timely surgery. The intervention consisted of (1) a real-time warning system to identify unmet care milestones, (2) race-specific feedback on lung cancer treatment rates, and (3) patient navigation. The primary outcome was surgery within 8 weeks of diagnosis. Risk ratios (RRs) and 95% CIs were estimated using log-binomial regression and adjusted for clinical and demographic factors. RESULTS A total of 2,363 patients with stage I and II non–small-cell lung cancer were included in the analyses: intervention (n = 263), retrospective control (n = 1,798), and concurrent control (n = 302). 87.1% of Black patients and 85.4% of White patients in the intervention group ( P = .13) received surgery within 8 weeks of diagnosis compared with 58.7% of Black patients and 75.0% of White patients in the retrospective group ( P < .01) and 64.9% of Black patients and 73.2% of White patients ( P = .29) in the concurrent group. Black patients in the intervention group were more likely to receive timely surgery than Black patients in the retrospective group (RR 1.43; 95% CI, 1.26 to 1.64). White patients in the intervention group also had timelier surgery than White patients in the retrospective group (RR 1.10; 95% CI, 1.02 to 1.18). CONCLUSION Accountability for Cancer Care through Undoing Racism and Equity is associated with timelier lung cancer surgery and reduction of the racial gap in timely surgery.

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“…14,15 Similar to this study, some studies have investigated the consequences of the delayed start of the treatment in the OS. Heiden et al 16 have found that for each week of surgical delay beyond 12 weeks, the risk for recurrence increased by 0.4% (HR = 1.004; 95% CI: 1.001-1.006; p = 0.002), and those with surgical treatment within 12 weeks of diagnosis had significantly better OS than the patients with procedures delayed more than 12 weeks (HR = 1.132; 95% CI: 1.064-1.204; p < 0.001). Samsom et al 17 have found that delayed surgery was associated with increased 30-day mortality (2.9% vs. 2.4%; p = 0.01) and decreased median survival (57.7 ± 1.0 vs. 69.2 ± 1.3 months; p < 0.001), related to nondelayed Stage-I NSCLA patients, respectively.…”

Section: Discussionmentioning

confidence: 99%

Overall survival and prognostic factors in Stage I lung adenocarcinoma treated with curative intent: A real‐life 19‐year cohort study

Abrão

Abreu

Silva

et al. 2022

Journal of Surgical Oncology

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Objectives Important differences in Stage I non–small‐cell lung cancer (NSCLC) are related to the delay in the diagnosis to the treatment, hospitals' specialised status, comorbidities, tumour stage and histological type. Methods A 19‐year retrospective cohort study was conducted, including 681 patients with NSCLC in clinical‐stage IA–IB. The variables analysed were gender, age, schooling, type of health care provider, type of treatment, period of 5‐year treatment, the time between first attendance to diagnosis and the time between diagnosis and treatment, and hospital's specialised status. Results Patients who underwent radiotherapy alone had three times more risk of death than those who underwent surgery alone (adjusted hazard ratio [adjHR] = 3.44; 95% confidence interval [CI]: 2.45–4.82; p <0.001). The independent risk of death factors was being treated in nonhigh complexity centres in oncology hospitals and having started the treatment more than 2 months after diagnosis (adjHR = 1.80; 95% CI: 1.26–2.56; p <0.001) and (adjHR = 2.00; 95% CI: 1.33–3.00; p <0.001), respectively. In addition, the patients diagnosed between 2011 and 2015 had a 40% lower risk of death when compared to those diagnosed between 2000 and 2005 (95% CI: 0.38–0.94; p = 0.027). Conclusion The overall survival in curative intent Stage‐I lung cancer patients' treatment was associated with the 5‐year diagnosis group, the delayed time between diagnosis and treatment and the hospital qualification.

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Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer

Cited by 75 publications

References 34 publications

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

Effect of an Antiracism Intervention on Racial Disparities in Time to Lung Cancer Surgery

Overall survival and prognostic factors in Stage I lung adenocarcinoma treated with curative intent: A real‐life 19‐year cohort study

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