Discrepancies in Chemotherapy and Radiation Start Times for Non-Small Cell Lung Cancer Patients

Abstract

Discordant chemotherapy and radiation start times increase treatment length in patients with non-small cell lung cancer. Previous studies have indicated that increased treatment length negatively impacts overall survival. Risk factors for these discrepancies have yet to be identified; however, linguistic and social disparities may play a role. This study addresses whether treatment location, language preference, ethnicity, or socioeconomic status contribute to chemoradiation start time discrepancies. This retrospective analysis included patients with non-metastatic, biopsy proven non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation at either a private academic hospital or an adjacent county hospital between 01/01/2015 and 04/31/2017. Variables analyzed included age, gender, race, ethnicity, socioeconomic status, treatment location, language preference, treatment modality, and comorbidity. Radiation and chemotherapy start dates, and the time difference between these dates, were collected retrospectively. Univariable (UVA) and multivariable (MVA) analyses were conducted using the Poisson regression model. A total of 54 patients were included in the final statistical analysis. 68% of patients were treated at the private academic hospital and 32% of patients were treated at the adjacent county hospital. 40% of patients were Non-Hispanic White (NHW), 47% of patients were Hispanic, and 13% of patients were Non-Hispanic Black (NHB). On MVA, Hispanic ethnicity as compared to NHW ethnicity (RR 0.69, p = 0.001) and treatment at the private academic hospital as compared to the county hospital (RR 0.70, p = 0.001) were associated with a shorter gap between radiation and chemotherapy start times. In contrast, NHB ethnicity as compared to NHW ethnicity (RR 1.31, p < 0.001) was associated with a longer gap between start times. Differences in socioeconomic status and language preference were not statistically significant on MVA. NHB race and treatment at the county hospital were associated with discordant treatment. Quality improvement interventions are needed to improve these disparities in treatment delivery.