NSCLC Time To Treatment Predicts Overall Survival

Each additional week between diagnosis of early-stage NSCLC and time to first surgery may increase the risk of death by 4%

medwireNews: Research indicates that a delay between diagnosis and surgery significantly reduces the likelihood of survival of patients diagnosed with stage I or II non-small-cell lung cancer (NSCLC).

The study of 174 patients attending the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins between 2003 and 2009 shows that, on average, there were 61.2 days between the community diagnosis and first contact at the centre after referral for treatment, with a further 5.9 days until initiation of treatment.

The researchers found no significant difference in the overall survival (OS) of the 52 patients treated within 42 days of diagnosis - considered to be timely care - and the 122 patients whose surgery began more than 42 days after diagnosis.

However, when the interval between diagnosis and surgery was considered as a continuous variable, increasing time to surgery significantly reduced OS, report Norma Kanarek and co-workers, at Johns Hopkins University in Baltimore, Maryland, USA.

In Cox proportional hazard analysis, the likelihood of patient death was increased by each additional week of delay between diagnosis and additional surgery (hazard ratio [HR]=1.04), each additional year of age at diagnosis (HR=1.02), diagnosis of stage IIB disease (HR=2.14) and a tumour size greater than 4 cm in diameter or of unknown size (HR=4.78).

“One impediment to timely treatment may be attitudes around treatment of lung cancer because of the stigma of smoking – physician or patient nihilism,” the authors suggest, noting that breast cancer patients at their institute have a shorter interval between diagnosis and surgery than their NSCLC counterparts, and are significantly more likely to be treated within 3 weeks.

Writing in the American Journal of Medicine, the team comments: “Patients would profit from universal consideration of lung cancer as an urgent condition that merits full attention and rapid response to reduce tumor burden among patients with small, early stage tumors.

“In a position to treat afflicted patients, primary care providers and specialists are obligated to look at their own unconscious bias as a matter of life and death to these patients and to assure that early stage lung cancer patients are treated most efficaciously and effectively – with timely surgery.”


Kanarek N, Hooker C, Mathieu L, et al. Survival after community diagnosis of early stage non-small cell lung cancer. Am J Med; Advance online publication January 30, 2014. doi:10.1016/j.amjmed.2013.12.023.

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