Wait times between lung cancer diagnosis and surgery: national trends, disparities, and impact on long-term survival

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Background: The survival difference associated with delays between lung cancer diagnosis and definitive surgery is poorly defined in contemporary practice. The aim of this study was to evaluate the prevalence of treatment delays, trends in wait times, and survival impact in a national cohort. Methods: All patients with stage I or II non-small cell lung cancer (NSCLC) undergoing anatomic resection in the U.S. from 2004 to 2018 were identified in the National Cancer Database (NCDB). The association between survival and the interval between diagnosis and surgery was evaluated. Cox regression, logistic regression, and propensity score matching were used to adjust for differences in patient characteristics. Results: Between 2004-2018, 1,898,210 patients were diagnosed with lung cancer and 219,723 met the inclusion criteria. The median time between diagnosis and surgery was 30.5 [interquartile range (IQR), 5-50] days. The median wait time increased from 25 (IQR, 0-47) days in 2004 to 38 (IQR, 17-59) days in 2018 (P<0.001). After 1:1 propensity matching, the group contained 83,839 patients with one group waiting >4 and the other ≤4 weeks for surgery. The median age was 68 years and 45.7% [76,647] were men (P<0.6). Overall survival in the propensity matched group was significantly worse in patients waiting >4 weeks for definitive surgery compared with those waiting ≤4 weeks for stage I and II patients (P<0.001). Additionally, significant racial disparities in the interval between diagnosis and surgery were observed. The median wait time for non-Hispanic White patients was 31.0 (IQR, 8-52) days. Non-Hispanic Black patients waited 37.0 (IQR, 9-62) days, adjusted odds ratio (aOR) 1.2 [95% confidence interval (CI): 1.23-1.32, P<0.001] and Hispanic/Latino patients waited 32.0 (IQR, 2-55) days, aOR 0.95 (95% CI: 0.90-1.01, P<0.08). Conclusions: Wait times exceeding 4 weeks between lung cancer diagnosis and surgery for stage I and II NSCLC are increasingly common, particularly among non-Hispanic Black patients, and are associated with worse long-term survival. Reducing time between cancer diagnosis and surgery may represent a therapeutic target to mitigate healthcare disparities.

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