Exploring Clinical Pathways to a Metastatic Lung Cancer Diagnosis: A Latent Class Analysis Using North Carolina
Lorinda A Coombs1,2,3, Xi Zhou2, Katherine E Reeder-Hayes2,4
1School of Nursing, University of North Carolina, Chapel Hill, North Carolina.
Summary
Nearly two-thirds of patients with metastatic non-small cell lung cancer (NSCLC) accessed healthcare before diagnosis, but many had minimal contact. Healthcare utilization patterns impact biomarker testing rates, highlighting disparities in precision oncology access.
Area of Science:
- Oncology
- Health Services Research
- Cancer Epidemiology
Background:
- Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality.
- Metastatic NSCLC diagnosis has a poor five-year survival rate (12%).
- Identifying pre-diagnostic clinical pathways is crucial for improving outcomes.
Purpose of the Study:
- To identify clinical pathways preceding metastatic non-small cell lung cancer (NSCLC) diagnosis.
- To examine healthcare utilization patterns before diagnosis.
- To assess associations between pathways and tumor molecular testing.
Main Methods:
- Latent class analysis of linked registry and claims data for metastatic NSCLC patients (2015-2019).
- Examined pre-diagnostic encounters: ambulatory, hospital, emergency, screening, and specialist visits.
- Evaluated predictors of pathway membership and links to molecular testing.
Main Results:
- Four distinct patient pathways emerged: comprehensive (12%), emergency (24%), primary care (27%), and low healthcare users (37%).
- Pathway membership significantly correlated with molecular testing rates.
- Primary care users showed higher biomarker testing; emergency and low-utilization groups had lower rates.
Conclusions:
- Despite healthcare engagement, over one-third of patients had minimal pre-diagnostic contact.
- Disparities in molecular testing across pathways suggest unequal access to precision oncology.
- Targeted interventions for low-contact and emergency users may improve diagnostic equity and outcomes.
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