Introduction: Timeliness of management is important for patients diagnosed with Non-Small Cell Lung Cancer (NSCLC). Delays in management increase the risk of disease progression and potentially impact on survival.
Aims: Measure timeliness of management of NSCLC patients in South Western Sydney Local Heath District (SWSLHD) and evaluate factors that impact on this.
Methodology: A retrospective cohort of South Western Sydney (SWS) patients with newly diagnosed NSCLC from 2006-2012 was identified from the SWSLHD Clinical Cancer Registry. Benchmark time intervals evaluated were “Diagnosis to Initial Management” within 31 days and “Referral to Initial Management” within 42 days for specific treatment types. Negative binomial regression was used to determine factors associated with timeliness of care.
Results: 1926 patients with NSCLC were identified with a median age of 70 years. 61.9% were male and 51.5% were born overseas. Stage distribution was I&II, III, IV and unknown in 21.5%, 23.4%, 49.8% and 5.2% respectively. Initial management was palliative care 31.7%, radiotherapy 25.9%, surgery 16.3% and systemic therapy 15.9%. Median time from diagnosis to initial management was 32 days (IQR 15-58) overall, 19 days (IQR 9-46) for palliative care, 35 days (IQR 20-60) for radiotherapy, 37 days (IQR 24-57) for systemic therapy and 48 days (IQR 23-71) for surgery. Median time from referral to initial management was 21 days (IQR 13-32) for radiotherapy, 25 days (IQR 15-35) for chemotherapy and 35 days (IQR 21-49) for surgery. On multivariable analysis, factors associated with longer diagnosis to management intervals were older age (>60y), overseas-born, ECOG performance status 0-1 and Stage I-III. 50.1% of patients had a diagnosis to management interval >31 days and 11.9%, 17.8% and 34.8% had a referral to management interval >42 days for radiotherapy, chemotherapy and surgery respectively.
Conclusion: A significant proportion of patients are not meeting published benchmarks for timeliness of care in NSCLC.