Daniel R Gomez1, Kai-Ping Liao2, Stephen G Swisher3, George R Blumenschein4, Jeremy J Erasmus5, Thomas A Buchholz6, Sharon H Giordano7, Benjamin D Smith6. 1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: dgomez@mdanderson.org. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, United States. 3. Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States. 4. Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. 5. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, United States. 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. 7. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
Abstract
PURPOSE: Prompt staging and treatment are crucial for non-small cell lung cancer (NSCLC). We determined if predictors of treatment delay after diagnosis were associated with prognosis. MATERIALS AND METHODS: Medicare claims from 28,732 patients diagnosed with NSCLC in 2004-2007 were used to establish the diagnosis-to-treatment interval (ideally ⩽35days) and identify staging studies during that interval. Factors associated with delay were identified with multivariate logistic regression, and associations between delay and survival by stage were tested with Cox proportional hazard regression. RESULTS: Median diagnosis-to-treatment interval was 27days. Receipt of PET was associated with delays (57.4% of patients with PET delayed [n=6646/11,583] versus 22.8% of those without [n=3908/17,149]; adjusted OR=4.48, 95% CI 4.23-4.74, p<0.001). Median diagnosis-to-PET interval was 15days; PET-to-clinic, 5days; and clinic-to-treatment, 12days. Diagnosis-to-treatment intervals <35days were associated with improved survival for patients with localized disease and those with distant disease surviving ⩾1year but not for patients with distant disease surviving <1year. CONCLUSION: Delays between diagnosing and treating NSCLC are common and associated with use of PET for staging. Reducing time to treatment may improve survival for patients with manageable disease at diagnosis.
PURPOSE: Prompt staging and treatment are crucial for non-small cell lung cancer (NSCLC). We determined if predictors of treatment delay after diagnosis were associated with prognosis. MATERIALS AND METHODS: Medicare claims from 28,732 patients diagnosed with NSCLC in 2004-2007 were used to establish the diagnosis-to-treatment interval (ideally ⩽35days) and identify staging studies during that interval. Factors associated with delay were identified with multivariate logistic regression, and associations between delay and survival by stage were tested with Cox proportional hazard regression. RESULTS: Median diagnosis-to-treatment interval was 27days. Receipt of PET was associated with delays (57.4% of patients with PET delayed [n=6646/11,583] versus 22.8% of those without [n=3908/17,149]; adjusted OR=4.48, 95% CI 4.23-4.74, p<0.001). Median diagnosis-to-PET interval was 15days; PET-to-clinic, 5days; and clinic-to-treatment, 12days. Diagnosis-to-treatment intervals <35days were associated with improved survival for patients with localized disease and those with distant disease surviving ⩾1year but not for patients with distant disease surviving <1year. CONCLUSION: Delays between diagnosing and treating NSCLC are common and associated with use of PET for staging. Reducing time to treatment may improve survival for patients with manageable disease at diagnosis.
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