1318MO - Time to diagnosis among patients with cancer in the US

Background

Cancer patients may present to a healthcare provider with signs and symptoms without a clear diagnosis pathway. This often leads to a lengthy diagnosis process, treatment delay, poor outcomes, and high costs. Limited evidence on cancer diagnosis durations in the United States (US) exists. This study quantified time to diagnosis (TTD) among patients diagnosed with cancer in the US.

Methods

A retrospective claims analysis of patients newly diagnosed with cancer in 2018-2019 was conducted using Optum’s de-identified Clinformatics® Data Mart Database, which includes Medicare Advantage and commercially insured members. Patients were identified using ICD-10 codes requiring ≥2 outpatient visits ≥30 days apart or 1 inpatient visit without a prior cancer claim. The first diagnostic test was selected by reviewing the records for diagnostic tests prior to the cancer diagnosis until a gap of >60 days was observed. The index date was defined as the first diagnostic test date or, if available, the office visit date closest to and <4 weeks prior to the first diagnostic test. The TTD (time from index to cancer diagnosis date) was summarized descriptively and by tumor type.

Results

A total of 458,818 patients were identified across 20 cancer types with a mean age of 71 years, a mean Charlson comorbidity index of 2.1, and 50% were male. Breast (26%), prostate (19%), lung (13%), urothelial and bladder (9%), and kidney (8%) cancers were most prevalent. Mean TTD was 5.2 months (median=3.9 months, SD=5.5 months) and varied across cancer types and among patients with the same cancer type; 15.4% of patients had a TTD of >6 months. Multiple myeloma (52.8%), stomach (48.8%), esophagus (46.1%), colorectal (44.6%), lymphoma (31.9%), kidney (28.7%), and gallbladder (26.5%) cancers had more than a quarter of patients with >6 months TTD.

Conclusions

A non-trivial proportion of patients newly diagnosed with cancer experienced a lengthy diagnosis process of >6 months with large heterogeneity across patients and cancer types, highlighting cancer diagnosis inefficiency in the US. Policies, guidelines, and interventions that streamline cancer diagnosis pathways are critical to optimize patient outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

*GRAIL LLC, a subsidiary of Illumina, Inc., *Currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021.

Funding

*GRAIL, LLC, a subsidiary of Illumina, Inc., *Currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021.

Disclosure

M.D. Gitlin: Non-Financial Interests, Institutional, Funding: GRAIL. N. McGarvey: Non-Financial Interests, Institutional, Funding: GRAIL . N. Shivaprakash: Non-Financial Interests, Institutional, Funding: GRAIL . Z. Cong: Financial Interests, Personal, Stocks/Shares: GRAIL .