BACKGROUND: Conflicting evidence currently exists regarding the causes and effects of delay of care in non-small cell lung cancer (NSCLC). We hypothesized that delayed surgery in early-stage NSCLC is associated with worse short-term and long-term outcomes. METHODS: Treatment data of clinical stage I NSCLC patients undergoing surgical resection were obtained from the National Cancer Data Base (NCDB). Treatment delay was defined as resection 8 weeks or more after diagnosis. Propensity score matching for patient and tumor characteristics was performed to create comparable groups of patients receiving early (less than 8 weeks from diagnosis) and delayed surgery. Multivariable regression models were fitted to evaluate variables influencing delay of surgery. RESULTS: From 1998 to 2010, 39,995 patients with clinical stage I NSCLC received early surgery, while 15,658 patients received delayed surgery. Of these, 27,022 propensity-matched patients were identified. Those with a delay in care were more likely to be pathologically upstaged (18.3% stage 2 or higher versus 16.6%, p < 0.001), have an increased 30-day mortality (2.9% vs 2.4%, p = 0.01), and have decreased median survival (57.7 ± 1.0 months versus 69.2 ± 1.3 months, p < 0.001). Delay in surgery was associated with increasing age, non-white race, treatment at an academic center, urban location, income less than $35,000, and increasing Charlson comorbidity score (p < 0.0001 for all). Delayed patients were more likely to receive a sublobar resection (17.2% vs 13.1%, p < 0.001). CONCLUSIONS: Patients receiving delayed resection for clinical stage I NSCLC have higher comorbidity scores that may affect ability to perform lobectomy and result in higher perioperative mortality. However, delay in resection is independently associated with increased rates of upstaging and decreased median survival. Strategies to minimize delay while medically optimizing higher risk patients are needed.
BACKGROUND: Conflicting evidence currently exists regarding the causes and effects of delay of care in non-small cell lung cancer (NSCLC). We hypothesized that delayed surgery in early-stage NSCLC is associated with worse short-term and long-term outcomes. METHODS: Treatment data of clinical stage I NSCLCpatients undergoing surgical resection were obtained from the National Cancer Data Base (NCDB). Treatment delay was defined as resection 8 weeks or more after diagnosis. Propensity score matching for patient and tumor characteristics was performed to create comparable groups of patients receiving early (less than 8 weeks from diagnosis) and delayed surgery. Multivariable regression models were fitted to evaluate variables influencing delay of surgery. RESULTS: From 1998 to 2010, 39,995 patients with clinical stage I NSCLC received early surgery, while 15,658 patients received delayed surgery. Of these, 27,022 propensity-matched patients were identified. Those with a delay in care were more likely to be pathologically upstaged (18.3% stage 2 or higher versus 16.6%, p < 0.001), have an increased 30-day mortality (2.9% vs 2.4%, p = 0.01), and have decreased median survival (57.7 ± 1.0 months versus 69.2 ± 1.3 months, p < 0.001). Delay in surgery was associated with increasing age, non-white race, treatment at an academic center, urban location, income less than $35,000, and increasing Charlson comorbidity score (p < 0.0001 for all). Delayed patients were more likely to receive a sublobar resection (17.2% vs 13.1%, p < 0.001). CONCLUSIONS:Patients receiving delayed resection for clinical stage I NSCLC have higher comorbidity scores that may affect ability to perform lobectomy and result in higher perioperative mortality. However, delay in resection is independently associated with increased rates of upstaging and decreased median survival. Strategies to minimize delay while medically optimizing higher risk patients are needed.
Authors: M Elisabeth Del Giudice; Sheila-Mae Young; Emily T Vella; Marla Ash; Praveen Bansal; Andrew Robinson; Roland Skrastins; Yee Ung; Robert Zeldin; Cheryl Levitt Journal: Can Fam Physician Date: 2014-08 Impact factor: 3.275
Authors: Kevin Fiscella; Elizabeth Whitley; Samantha Hendren; Peter Raich; Sharon Humiston; Paul Winters; Pascal Jean-Pierre; Patricia Valverde; William Thorland; Ronald Epstein Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-10 Impact factor: 4.254
Authors: Maude Trepanier; Tiffany Paradis; Araz Kouyoumdjian; Teodora Dumitra; Patrick Charlebois; Barry S Stein; A Sender Liberman; Kevin Schwartzman; Franco Carli; Gerald M Fried; Liane S Feldman; Lawrence Lee Journal: J Gastrointest Surg Date: 2019-07-31 Impact factor: 3.452
Authors: Vignesh Raman; Oliver K Jawitz; Soraya L Voigt; Chi-Fu J Yang; Hanghang Wang; David H Harpole; Thomas A D'Amico Journal: J Thorac Cardiovasc Surg Date: 2019-10-08 Impact factor: 5.209
Authors: Elizabeth M Whitley; Peter C Raich; Donald J Dudley; Karen M Freund; Electra D Paskett; Steven R Patierno; Melissa Simon; Victoria Warren-Mears; Frederick R Snyder Journal: Cancer Date: 2016-09-20 Impact factor: 6.860
Authors: Pamela Samson; Traves Crabtree; Stephen Broderick; Daniel Kreisel; A Sasha Krupnick; G Alexander Patterson; Bryan Meyers; Varun Puri Journal: Ann Thorac Surg Date: 2016-09-21 Impact factor: 4.330