Examining Treatment Delay Trends in Patients With Lung Cancer

An analysis published in the Journal of Clinical Oncology focusing on lung cancer patients in Missouri reveals a concerning increase in treatment initiation delays, exceeding national guidelines and calling for further investigation into potential causes.

Lung cancer is a significant health challenge globally, with Missouri's incidence rate of 68.1% surpassing the national rate of 54%. The state ranks second for both men and women, highlighting the disease burden. Timely treatment is crucial for improving outcomes, with recommendations from the Institute of Medicine, RAND Corporation, and Healthy People 2030 Initiative stressing the importance of prompt care to reduce incidence and mortality rates. The study aimed to assess delays in treatment initiation post-diagnosis and investigate Missouri's adherence to treatment delay guidelines in lung cancer patients.

Adults older than 18 years with a diagnosis of lung cancer were identified using ICD-10 codes C50.0-C50.9 from the Missouri Cancer Registry and Research Center database for the years 2012 through 2022. Data completeness rates were at least 95% for all years except 2022, which had a completion rate of 90%. Treatment delays were assessed using the RAND guidelines 42-day rule and the MCAP's 30-day metric by calculating the difference between the Date of Initial Diagnosis and the Date of First Course Treatment, with records that had missing or incomplete dates excluded. The data processing and analyses were conducted using Python 3.11.

The study included 68 293 adult patients with lung cancer and revealed that 7882 were excluded due to missing or incomplete data. Out of the remaining 60 411 patients, 89.5% were Caucasian with a median age of 69 and nearly equal gender distribution. The average time from diagnosis to treatment was 36.8 days, and about 31.2% of patients experienced a delay of over 42 days. The study showed a rise in delays over the years, from 26.3% in 2012 to 42.6% in 2022.

“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,” said researchers. “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.”

Reference
Chelapareddy L R, Beheshti M, Naha K, et al. Time to treatment initiation: an assessment of trends in delays in patients with lung cancer across Missouri. Journal of Clinical Oncology. 2024;42(16). doi:10.1200/JCO.2024.42.16_suppl.11186