Geographic variation in delay to surgical treatment among non-small cell lung cancer patients

Delayed surgery is significantly associated with an increased risk of disease progression and adverse outcomes in lung cancer. Evidence is available on the variation in delayed surgical treatment among patients with Non-Small Cell Lung Cancer (NSCLC). However, the relative contribution of patient- and area-level risk factors to the geographic patterns of delayed surgery in patients with NSCLC is poorly understood. Therefore, we aimed to explore the geographic variation in delay to surgical treatment among patients with NSCLC.

This study utilized data from the Victorian Lung Cancer Registry (VLCR) and the Australian Bureau of Statistics (ABS). A total of 3,088 patients with NSCLC who had undergone surgery were included. We applied a Bayesian spatial multilevel model incorporating spatially structured and unstructured random effects to examine patient and area-level risk factors associated with delays to surgical treatment. Model comparison was conducted using the Deviance Information Criterion (DIC).

Over one-third (40.45 %) of NSCLC patients experienced delayed surgical treatment. Significant geographic variation in delayed surgical treatment among NSCLC patients across Local Government Areas (LGAs) was observed. Factors significantly associated with higher odds of delayed surgical treatment included clinical stage II (AOR = 1.56, 95 % CrI: 1.26-1.92), stage III (AOR = 1.90, 95 % CrI: 1.46-2.47), stage IV (AOR = 2.04, 95 % CrI: 1.15-3.61), treatment at inner regional hospitals (AOR = 2.86, 95 % CrI: 2.17-3.70), presence of comorbidities (AOR = 1.19, 95 % CrI: 1.02-1.40), and diagnosis during the COVID-19 pandemic (AOR = 1.32, 95 % CrI: 1.10-1.57).

This study highlights the need to improve the treatment pathway for patients with NSCLC by reducing the time between diagnosis and surgery. Future targeted initiatives are essential to promote timely surgeries for NSCLC patients, especially in high-need areas.