The Association between Sociodemographic Factors and Delays to Minimally Invasive Surgery for Stage IA-IIIA Non-Small Cell Lung Cancer

Background: Surgical resection is the gold standard treatment for early-stage non-small cell lung cancer (NSCLC). Prior studies have found that delayed treatment carries risk of disease progression. However, factors that predict delay to surgery are relatively understudied. The aim of this study was to identify characteristics associated with time-to-surgery.

Methods: The National Cancer Database was queried for patients with stage IA-IIIA NSCLC who underwent upfront resection from 2017-2021. The primary outcome was time-to-surgery examined as a continuous and categorical variable in which patients were divided into timely (≤6 weeks) and delayed (>6 week) surgery cohorts.

Results: Across 75,047 patients, median [interquartile range] time-to-surgery was 41 [19-64] days. Of these patients, 39,685 (52.9%) were in the timely and 35,362 (47.1%) were in the delayed cohort. Following risk-adjustment, significant predictors of increased odds of delayed surgery included African-American race (odds ratio 1.46 [95% confidence interval 1.34-1.59]), lack of insurance (1.70 [1.33-2.17]), lower educational status (1.15 [1.04-1.25]), lower household income (1.40 [1.28-1.54]), and utilization of a robotic-assisted approach (1.21 [1.15-1.27]). Patients whose surgery was delayed had significantly increased risk-adjusted odds of upstaging (1.15 [1.04-1.28]), 30-day mortality (1.24 [1.02-1.52]), and 90-day mortality (1.25 [1.08-1.45]).

Conclusions: Following risk-adjustment for oncologic characteristics, sociodemographic factors are associated with delay to definitive surgery in NSCLC and subsequent increased odds of mortality and pathologic upstaging. Future work should explore strategies to improve availability and accessibility of timely treatment for these patient populations to ameliorate disparities in care for NSCLC.