Delays in radiation therapy as a result of insurance peer-to-peer prior authorizations among lung cancer patients

Abstract

Lung cancer is the leading cause of cancer death in the USA and timely treatment plays a major role in the prognosis. Peer-to-peer insurance prior authorizations are believed to represent a major cause of treatment delays. However, the effect of peer-to-peer prior authorizations on radiotherapy treatment delays in lung cancer remains unknown. We reviewed departmental treatment records between September 2015 and 2018 for patients who received radiation therapy (RT) with curative intent for lung cancer. Our primary endpoint was delay in RT initiation; delay in RT simulation served as a secondary endpoint. Univariate and multivariate logistic regressions were used to estimate the effect of peer-to-peer reviews on treatment delays of at least 7 days. Two hundred and seventy patients were included. The median treatment delay was 6.5 days for those requiring peer-to-peer review versus 1 day for those who did not (Wilcoxon rank-sum test, p = 0.002). Univariate logistic regression found peer-to-peer review to be strongly correlated with a delay in start of treatment (OR = 3.58, p = 0.002) and simulation (OR = 9.24, p < 0.001); this effect persisted on multivariate analysis. Time trend analysis found that utilization of peer-to-peer reviews increased in frequency over our study period (p < 0.001). Peer-to-peer reviews were strongly correlated with delay in RT treatment and planning. This insurance practice has additionally become more prevalent over time. A more streamlined process is needed to address this issue.