Impact of time-to-treatment on survival for advanced non-small cell lung cancer patients in the Netherlands: a nationwide observational cohort study

Abstract

BackgroundThe assumption that more rapid treatment improves survival of advanced non-small cell lung cancer (NSCLC) has not yet been proven. We studied the relation between time-to-treatment and survival in advanced stage NSCLC patients in a large multicentric nationwide retrospective cohort. Additionally, we identified factors associated with delay.MethodWe selected 10 306 patients, diagnosed and treated between 2014 and 2019 for clinical stage III and IV NSCLC, from the Netherlands Cancer Registry that includes nationwide data from 109 Dutch hospitals. Associations between survival and time-to-treatment were tested with Cox proportional hazard regression analyses. Time-to-treatment was adjusted for multiple covariates including diagnostic procedures and type of therapy. Factors associated with delay were identified by multilevel logistic regression.ResultsRisk of death significantly decreased with longer time-to-treatment for stage III patients receiving only radiotherapy (adjusted HR, aHR >21 days: 0.59 (95% CI 0.48 to 0.73)) or any type of systemic therapy (aHR >49 days: 0.72 (95% CI 0.56 to 0.91)) and stage IV patients receiving chemotherapy and/or immunotherapy (aHR >21 days: 0.81 (95% CI 0.73 to 0.88)). No significant association was found for stage III patients treated with chemoradiotherapy and stage IV patients treated with targeted therapy. More complex diagnostic procedures often delay treatment.ConclusionAlthough in general it is important to start treatment as early as possible, our study finds no evidence that a more rapid start of treatment improves outcomes in advanced stage NSCLC patients. The benefit of urgent treatment is probably confounded by unmeasured patient and tumour characteristics and, clinical urgency dictating timelines of treatment. Time-to-treatment and its impact should be continuously evaluated as therapeutic strategies continue to evolve and improve.

A long waiting time from diagnosis to treatment decreases the survival of non-small cell lung cancer patients with stage IA1: A retrospective study

“…However, they only analyzed the data of 495 patients in one cancer center. A recent report from Klarenbeek SE et al based on a nationwide observational cohort study presented that a more rapid start of therapy did not improve survival outcomes in NSCLC patients with advanced stage ( 10 ). The abovementioned research mainly collected NSCLC patients with clinical stage III-IV, though its sample size was large.…”

“…The effect of delayed treatment on the survival of NSCLC patients was inconsistent ( 8 – 10 , 20 , 21 ). There are two main reasons for this phenomenon.…”

“…Some patients received timely therapy; perhaps the emergency treatment was due to the urgency of the condition. Therefore, the poorer prognosis of such patients should be due to the condition itself and not to the length of waiting time before therapy ( 10 ). On the other hand, some patients did not receive complete essential checks, although those patients underwent timely treatment.…”

“…However, the conclusions from those studies were inconsistent. Some research suggested that a long waiting time from diagnosis to treatment could decrease the survival outcomes ( 8 , 9 ), though other studies concluded that delay treatment did not affect the prognosis of patients significantly ( 10 , 11 ). Thus, there is always a need to investigate the prognostic effect of a long waiting time before treatment on non-small cell lung cancer (NSCLC) patients.…”

The characterization of tumor microenvironment infiltration and the construction of predictive index based on cuproptosis-related gene in primary lung adenocarcinoma

“…Lung cancer is still the leading cause of malignancies-related death worldwide (1). Non-small cell lung cancer accounts for 80-85% of all lung cancers, the major part of which is the type of adenocarcinoma (2,3). The prognosis of lung adenocarcinoma (LUAD) is not satisfactory in clinical practice (4,5).…”