Review of the treatment milestones for stage I non-small cell lung cancer at a regional rural cancer center.

Abstract

e18305 Background: Treatment milestones were reviewed for all stage I non-small cell lung cancer (NSCLC) patients treated at Northern Light Cancer Institute (NLCI), from 2010 to 2017. Cases in which the initial time to treatment (TTT) exceeded 6 months and those not seeking treatment were considered non-typical and were excluded from analysis, resulting in 502 cases for this time period. Methods: Analysis demonstrated that patients primarily took one of three different pathways in the diagnostic process. This process typically involved a CT scan, PET scan, and a biopsy. The three primary diagnostic pathways were: CT-PET-Biopsy (29.7%), CT-Biopsy-PET (14.3%), or CT-PET (no biopsy) (39.8%), accounting for 83.9% of eligible patients. The primary mode of treatment for most patients was surgery (63.7%). Patients not eligible for surgery received stereotactic body radiation therapy (SBRT) (26.7%). Results: Patients undergoing surgery experienced a shorter average TTT compared to patients receiving SBRT for all years except 2016. (p < 0.05). Time to treatment for surgical patients was stable at approximately 70 days from 2011-2014, at which time there was an average 27.9 day increase by 2016. TTT for SBRT patients increased from a mean of 67.4 days in 2010 to a high of 110.8 days in 2015 before decreasing to 90.0 in 2016. The different diagnostic pathways did not significantly differ from each other in terms of 3 year average TTT (2015-2017) for surgical patients (p = 0.59). SBRT patients who had a two-step diagnostic pathway (CT-PET) had TTT that was 22.7 days shorter than the three step pathway of CT-PET-Biopsy (p = 0.02). Patients receiving SBRT had a 1.56 points average higher Charlson Comorbidity Index, and were an average of 4.5 years older than those receiving surgery. Conclusions: Differences in TTT between treatment modalities are likely related to patient comorbidities and additional time needed for radiation planning and simulation. The changes seen since 2015 were thought to be secondary to the emergence of prior-authorization for procedures. This was a quality study aiming to identify the current treatment milestones and related wait times for each treatment modality in an effort to further optimize patient care.