Does Timeliness of Care in Non-Small Cell Lung Cancer Impact on Survival?

Objectives: To measure time intervals in the management of Non-Small Cell Lung Cancer (NSCLC) patients, identify factors associated with this and evaluate the impact of timeliness of care on survival.

Materials And Methods: A retrospective cohort of South Western Sydney (SWS) patients with newly diagnosed NSCLC from 2006 to 2012 was identified from the SWSLHD Clinical Cancer Registry. Time intervals evaluated in days were "Diagnosis to Initial Treatment" and "Referral to Initial Treatment". Treatment included surgery, radiotherapy, systemic therapy and palliative care. Negative binomial regression and Cox regression were used to identify factors associated with timeliness of care and survival respectively.

Results: 1926 NSCLC patients were identified of whom 1729 had initial treatment recorded. Initial treatment was palliative care in 35% (n=611), radiotherapy in 29% (n=498), surgery in 18% (n=314) and systemic therapy in 18% (n=306). Median time from diagnosis to treatment was 32days (IQR 15-58). Median time from specialist referral to treatment was 35days for surgery (IQR 21-49), 21days for radiotherapy (IQR 13-32) and 25days (IQR 15-35) for systemic therapy. On multivariable analysis, age between 70 and 79 years, ECOG performance status 0-1, Stage I-III NSCLC and systemic treatment were associated with longer Diagnosis to Treatment: intervals. Diagnosis to Treatment: interval was not associated with mortality in Stage I & II NSCLC. A longer interval was associated with reduced mortality in Stage III (HR 0.99, 95%CI 0.99-1.0, p=0.03) and Stage IV NSCLC (HR=0.99, 95% CI 0.99-0.99, p=0.0008).

Conclusions: At the population level, longer Diagnosis to Treatment: time intervals were not associated with adverse survival outcomes in NSCLC. However, delays to treatment may impact on other outcomes such as patient's psychological wellbeing and quality of life which were not measured in this study.