Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival

Abstract

Objective: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. Summary of Background Data: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. Methods: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of “early” versus “delayed” surgery (surgery received 0–30 vs 90–120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. Results: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). Conclusions: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration.

Delayed visit and treatment of lung cancer during the coronavirus disease 2019 pandemic in Japan: a retrospective study

“…The survival rate of patients was shorter for those who underwent treatment within 90 to 120 days from diagnosis compared with those who underwent treatment within 0 to 30 days. 6 It was unclear whether a pre-treatment delay of 69 days, as shown in our study, would induce a poor prognosis. Conversely, the time between preoperative diagnostic CT imaging and surgical treatment was reported to be associated with an increased risk of recurrence.…”

“…5 The period between diagnosis and treatment is associated with mortality in cancer. 6 In lung cancer, disease progression because of delayed treatment can reduce the chance of surgery. 5 The delay until treatment can be because of patient-or doctor-related reasons.…”

Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

“… 17 , 25 , 26 An association between worse survival and longer interval between the diagnosis of early-stage non–small cell lung cancer (NSCLC) and surgery has been reported. 27 , 28 , 29 A retrospective analysis of 2 cohorts from the NLST (n = 452) and the National Cancer Data Base (NCDB; n = 80 086) evaluated the association between outcomes and early (0 to 30 days) vs delayed (90 to 120 days) surgery for stage I adenocarcinoma and squamous cell cancer (SCC). 27 No significant difference was found in survival for stage 1A1 adenocarcinoma and 1A1-1A3 SCC (all P > .13); however, for larger tumors, stage 1A2-1B adenocarcinoma and stage 1B SCC, delayed surgery was associated with worse survival (all P < .004).…”

Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey

“…The negative impact of deferring surgical resection in patients with lung cancer is well known. Therapeutic delay has been shown to reduce survival rates, even in patients with early-stage disease (starting with stage IA2 adenocarcinoma and stage IB squamous carcinoma) [29]. As the survey was performed during the first phase of the pandemic, we do not have information about how any delays in diagnosis or detection of lung cancer might have affected the disease in terms of size, stage, or eligibility for curative surgery.…”