Treatment delays in non-small cell lung cancer (NSCLC) and their prognostic implications.

Abstract

6068 Background: The impact of treatment delays on NSCLC patients' survival is uncertain. While later treatment could negatively affect their psychological wellbeing, the maximum acceptable waiting time has not been determined. Methods: We analyzed consecutive patients diagnosed with NSCLC between January 2005 and May 2007 who received standard treatment at Hôpital du Sacré-Coeur de Montréal. Treatment delay was calculated from the first abnormal radiographic study. Patients were classified into three groups, based on TNM staging and the treatment received: localized (stages I and II), regional (most of stage III) and advanced (stages IIIB and IV). Cox proportional hazards analysis was used to identify predictive factors for survival among the following parameters: age, gender, histology, smoking status, type of treatment, tumor board discussion and treatment delay. Kaplan-Meier curves were used to estimate survival. Results: Three hundred twenty eight patients were identified. Their median treatment delay was 72 days (25%-75% interquartile range = 37-110 days), and distributed as follows: 85 (56-130) days for localized, 91 (37-120) days for regional and 50 (30-76) days for advanced stages (p < 0.01 for the latter). Treatment delay did not have a significant prognostic meaning for localized or regional stages. The opposite was true for advanced disease, both in univariate (p = 0.006) as well as multivariate (p = 0.009) analysis; for each week that the treatment could be delayed, the hazard ratio for mortality was improved at 0.93 (95% confidence interval 0.89-0.98). Survival of advanced patients who began treatment earlier versus later than 50 days was 6.8 months compared to 11.6 months (p = 0.027). None of the other factors were significant in uni or multivariate analyses. Conclusions: Treatment delays did not impact outcome in patients having localized or regional stage NSCLC in our cohort. For advanced stages, shorter treatment delays were associated with shorter survival. Rather than having a direct negative impact, this likely reflects that urgent treatment carried a negative prognostic meaning, as it was preferentially offered to patients having more aggressive disease. No significant financial relationships to disclose.