Time to treatment and survival in veterans with lung cancer eligible for curative intent therapy

The Institute of Medicine emphasizes care timeliness as an important quality metric. We assessed treatment timeliness in stage I-IIIA lung cancer patients deemed eligible for curative intent therapy and analyzed the relationship between time to treatment (TTT) and timely treatment (TT) with survival...

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Bibliographic Details
Published in:	Respiratory medicine Vol. 141; pp. 172 - 179
Main Authors:	Ha, Duc, Ries, Andrew L., Montgrain, Philippe, Vaida, Florin, Sheinkman, Svetlana, Fuster, Mark M.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2018 Elsevier Limited
Subjects:	Aged Cancer Cancer therapies Chemoradiotherapy Chemoradiotherapy - methods Comorbidity Curative intent treatment Disease-Free Survival Female Hazards Health care Histology Humans Lung cancer Lung Neoplasms - drug therapy Lung Neoplasms - pathology Lung Neoplasms - radiotherapy Lung Neoplasms - surgery Male Medical prognosis Medical records Medical referrals Medical treatment Middle Aged Neoplasm Staging Overall survival Patients Quality assessment Radiation Regression analysis Retrospective Studies Subgroups Surgery Survival Survival Analysis Therapy Time-to-Treatment Variables Veterans BTS DD TT UVA SCS Lung cancer Curative intent treatment HR TLC DFS ACCP DLCO TTT Time-to-treatment SEER SCLC NSCLC OS CI IOM CAD IQR MST CTB Disease-free survival SBRT PH MVA FEV1 Overall survival VASDHS mo's HF COPD
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Summary:	The Institute of Medicine emphasizes care timeliness as an important quality metric. We assessed treatment timeliness in stage I-IIIA lung cancer patients deemed eligible for curative intent therapy and analyzed the relationship between time to treatment (TTT) and timely treatment (TT) with survival. We retrospectively reviewed consecutive cases of stage I-IIIA lung cancer deemed eligible for curative intent therapy at the VA San Diego Healthcare System between 10/2010–4/2017. We defined TTT as days from chest tumor board to treatment initiation and TT using guideline recommendations. We used multivariable (MVA) Cox proportional hazards regressions for survival analyses. In 177 veterans, the median TTT was 35 days (29 days for chemoradiation, 36 for surgical resection, 42 for definitive radiation). TT occurred in 33% or 77% of patients when the most or least timely guideline recommendation was used, respectively. Patient characteristics associated with longer TTT included other cancer history, high simplified comorbidity score, stage I disease, and definitive radiation treatment. In MVA, TTT and TT [HR 0.53 (95% CI 0.27, 1.01) for least timely definition] were not associated with OS in stage I-IIIA patients, or disease-free survival in subgroup analyses of 122 stage I patients [HR 1.49 (0.62, 3.59) for least timely definition]. Treatment was timely in 33–77% of veterans with lung cancer deemed eligible for curative intent therapy. TTT and TT were not associated with survival. The time interval between diagnosis and treatment may offer an opportunity to deliver or improve other cancer care. •The median time to curative-intent treatment was 35 days in 177 veterans.•Curative-intent lung cancer treatment was not timely in 27–66% of veterans.•Time-to-treatment/timely treatment was not associated with better overall survival.•Time-to-treatment/timely treatment was not associated with disease-free survival.
ISSN:	0954-6111 1532-3064
DOI:	10.1016/j.rmed.2018.07.005