Time to treatment initiation: An assessment of trends in delays in patients with lung cancer across Missouri.
Authors: Lakshmi Ramya Chelapareddy, Mohammad Beheshti, Kushal Naha, Iris Zachary
Journal: Journal of Clinical Oncology (2024)

11186 Background: Lung cancer is a major health challenge globally. Missouri's incidence rate of 68.1% exceeds the national rate of 54.0% indicating a significant disease burden. It is the 2nd most common malignancy in men and women in the state. Timely treatment can significantly improve while delays can worsen outcomes. The Institute of Medicine strongly recommends efforts promoting timely care in lung cancer. The RAND Cooperation suggests treatment should begin within 6 weeks after diagnosis. These priorities align with the Healthy People 2030 Initiative which aims to reduce lung cancer incidence and mortality through enhanced screening and early treatment. The U.S. National Committee on Health Care identified a goal of 60% of lung cancer patients receiving treatment within 30-days of diagnosis. Our primary objective was to assess delays in treatment initiation post-diagnosis and to investigate Missouri’s adherence to treatment delay guidelines in lung cancer patients. Methods: Study population included adults (age&gt;18) with a diagnosis of Lung Cancer, identified using ICD-10 codes C50.0-C50.9. Records were retrieved from the Missouri Cancer Registry and Research Center database for the years 2012-2022. Data for 2022 had a completion rate of 90%, all others had at least 95% completeness. We used the RAND guidelines 42-day treatment delay rule and the Missouri Cancer Action Plan's (MCAP) 30 day treatment delay metric as our benchmarks. Treatment delay was determined by subtracting the Date of Initial Diagnosis from the Date of First Course Treatment. Records with missing or incomplete dates were excluded. Data processing and analyses were performed using Python 3.11. Results: Of the 68,293 adult lung cancer patients in the database, 7,882 were excluded due to missing or incomplete data. Among the eligible 60,411 patients, 89.5% were Caucasian, median age was 69 (range 18-105), gender distribution was nearly equal with males accounting for 51.3% of the total. Average time from diagnosis to treatment was 36.8 days, with a median of 27 days. About 31.2% of patients had a gap over 42 days from diagnosis to first treatment. This delay has risen from 26.3% in 2012 to 42.6% in 2022, marking a 16.3% increase. In terms of adherence to the MCAP’s 30 day treatment delay metric, 45.6% of patients experienced more than a 30-day gap between diagnosis and treatment. The trend shows an increase in delays, from 40.4% in 2012 to 58.1% in 2022, reflecting a 17.7% rise. Conclusions: Despite the declining incidence rate of lung cancer in Missouri over the years, our analysis revealed a surprising increase in treatment initiation delays over the years. The average time from diagnosis to treatment and the percentage of patients experiencing delays exceed the RAND guideline and the MCAP's treatment delay metric and with a rising trend from 2012 to 2022. Further analysis into factors causing delay in treatment initiation is needed and being planned.