Research paperDoes timeliness of care in Non-Small Cell Lung Cancer impact on survival?

- Time from diagnosis to treatment exceeded published benchmarks in approximately half of all NSCLC patients.
- Longer time intervals were seen in Stage I-III NSCLC and in ECOG 0-1 patients.
- Longer diagnosis to treatment intervals did not adversely impact on survival in those undergoing active treatment.

ObjectivesTo 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 methodsA 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.Results1926 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 32 days (IQR 15-58). Median time from specialist referral to treatment was 35 days for surgery (IQR 21-49), 21 days for radiotherapy (IQR 13-32) and 25 days (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).ConclusionsAt 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.