Timeliness of Lung Cancer Care From the Point of Suspicious Image at an Urban Safety Net Hospital by Demographic and Clinical Factors

Abstract

<h3>Purpose/Objective(s)</h3> Timeliness of care is an important metric for lung cancer patients, and care delays in the safety-net setting have been described. However, timeliness from the point of the suspicious image is not well-studied. Herein, we evaluate time intervals in the workup of lung cancer at an urban, safety net hospital and assess for disparities by demographic and clinical factors. <h3>Materials/Methods</h3> We performed a retrospective analysis of patients with lung cancer between 2015-2020. Median times from suspicious image to first treatment (I-T), suspicious image to diagnosis (I-D) and diagnosis to treatment (D-T) were calculated. Date of suspicious image was defined as the date that the imaging study prompting cancer-targeted workup resulted. Date of diagnosis was defined as date that biopsy first resulting in histologic diagnosis of lung cancer was performed. Non-parametric tests were applied to assess for intergroup differences in time intervals. <h3>Results</h3> A total of 687 patients were included in the final analysis, of whom 370 (53.9%) were male. By race, 328 (47.7%) were white, 248 (36.1%) were black, 47 (6.9%) were Hispanic, and the remaining 64 (9.3%) were of other racial groups. There were 235 stage I (34.2%), 54 stage II (7.9%), 125 stage III (18.2%), and 273 stage IV (39.7%) patients. I-T, I-D, and D-T for the entire cohort was 78, 34, and 32 days, respectively. Among females, the I-T was 87 days as compared to 72 days for males (p<0.01). By stage, the I-Ts were 106, 110, 81, and 41 days for stages I, II, III, and IV, respectively (p<0.01). The I-D was 40.5 and 45 days for black and Hispanic patients as compared to 28 and 23 days for white and Asian patients respectively (p<0.05, Table 1). <h3>Conclusion</h3> Advanced stage at presentation and male gender were associated with more timely treatment from the point of suspicious imaging while non-black or Hispanic race were associated with more timely lung cancer diagnosis without significant impact on time to treatment. Future analyses should seek to elucidate the drivers of differences in timeliness of care by these characteristics and assess for the impact of timeliness disparities on patient outcomes in the safety net setting.