Increasing time-to-treatment for resectable non–small cell lung cancer: Predictors and survival impact

Objective To identify predictors of prolonged time-to-treatment initiation (TTI) among patients undergoing lung cancer surgery and determine whether this prolongation correspond to survival differences in resectable disease. Methods We performed a retrospective cohort study of the National Cancer Database from 2018 to 2022. Patients with stage I-II non–small cell lung cancer were included; those with missing stage, treatment, or time-to-treatment data were excluded. Demographic, socioeconomic, clinical, treatment, and facility variables were analyzed. TTI was capped at 180 days to minimize outlier bias. Multivariable accelerated failure time models with gamma distribution were used to identify predictors of TTI prolongation. Survival was stratified by treatment initiation ≤30, 31 to 60, and >60 days. Results Among eligible patients, mean TTI increased from 51.5 days in 2018 to 61.3 days in 2022. In stage I disease, Black patients experienced 13% longer TTI versus White patients (time ratio [TR], 1.13; 95% CI, 1.11-1.14). Nonprivate insurance status was associated with significantly longer TTI, including Medicaid coverage (TR, 1.22; 95% CI, 1.19-1.24). Treatment at different facilities also added 14% TTI (TR, 1.14; 95% CI, 1.13-1.15). In stage I and II disease, treatment initiation within 30 days demonstrated significantly superior overall survival compared with treatment after 60 days ( P < .001). Conclusions TTI for non–small cell lung cancer has progressively lengthened in recent years and disproportionately affects socioeconomically vulnerable patient groups. Prolongations in TTI are associated with inferior survival, underscoring the need for system-level interventions to improve coordination, access, and delivery.