Time-to-Treatment Effects of Sociodemographic Patient Factors in Early-Stage Non-Small Cell Lung Cancer

Lung cancer causes the most cancer-related deaths in the United States. For patients with localized disease, expeditious treatment portends improved outcomes. This study explores relationships between patient factors and timely treatment for early-stage non-small cell lung cancer (NSCLC) in a population-based cancer registry.

All adult patients with localized NSCLC between January 1, 2015, and December 31, 2021, were identified through the Michigan Cancer Surveillance Program. Demographic and social factors were compared between treatment groups. Time-to-treatment was defined as days between diagnosis and initiation of first treatment. Multivariable Poisson regression was used to compare time-to-treatment across race, payer, and rural-urban continuum groups. Subset analysis stratifying by first treatment modality was performed.

A total of 10,618 patients with NSCLC were included, with 4753 undergoing operative resection, 5151 undergoing radiation therapy, and 894 undergoing systemic therapy. Overall mean time-to-treatment was 59.8 d (standard deviation [SD], 34.4), with time-to-surgery 57.4 d (SD, 32.9), time-to-radiation therapy 63.0 d (SD, 35.5), and time-to-systemic therapy 53.4 d (SD, 33.7). Adjusted time-to-treatment was longer in Black patients compared to White patients (incidence rate ratio [IRR]: 1.14, 95% confidence interval [CI]: 1.13-1.15, P < 0.001), longer in Medicaid patients compared to Medicare patients (IRR: 1.07, 95% CI: 1.06-1.09, P < 0.001), and shorter in patients in suburban areas compared to urban areas (IRR: 0.95, 95% CI: 0.94-0.97, P < 0.001). Subset analysis of patients undergoing operative resection yielded similar trends.

Sociodemographic factors, including race, payer, and geography, may influence treatment wait times for patients with NSCLC. This inspires further investigation of systems-based drivers of timely treatment and equitable cancer care.