Facility-Level Medical Oncology Specialist Availability and First-Line Time to Treatment Failure in Lung Cancer: A...

Japan's Center for Cancer Genomics and Advanced Therapeutics (C-CAT) provides a national platform for studying genomic-medicine-era care. We conducted a nationwide registry/database study to examine whether facility-level Japanese Society of Medical Oncology (JSMO) specialist availability was associated with first-line time to treatment failure (TTF) in lung cancer. The primary exposure was treating-facility JSMO specialist count (0-1 vs. ≥2); dual JSMO/Japanese Respiratory Society availability was a secondary lung-cancer-oriented exposure. First-line TTF was defined from systemic therapy start to recorded first-line treatment end or death, whichever occurred first. The cohort included 5456 patients at 241 facilities: 1477 in the 0-1 group and 3979 in the ≥2 group. Kaplan-Meier estimated median first-line TTF was 4.2 versus 5.1 months (log-rank p < 0.001). In the full clinical adjustment model, the HR for ≥2 versus 0-1 specialists was 0.911 (facility-cluster robust 95% CI, 0.806-1.029; robust p = 0.133). The point estimate was in the direction of longer recorded treatment-process duration, but the robust confidence interval included no association. Linking C-CAT with facility-level workforce data demonstrates a health-services use of national genomic registry data and supports the development of chemotherapy-specific databases with patient-level, time-anchored clinical information.