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Delays in Lung Cancer Treatment: Disparities by Race and Treatment Modality at an Urban Safety-Net Hospital
Jin Kook Kang, MD1, Michael Paolini2, Les Becker, PhD3, Charlotte Farley2, Alexander Boos2, John Lazar, MD1.
1Medstar Georgetown University Hospital, Washington, DC, USA, 2Georgetown Univesity School of Medicine, Washington, DC, USA, 3Medstar Health, Washington, DC, USA.

Objective: Lung cancer is the number one cause of cancer mortality in the US. Expediting time from diagnosis to treatment is key to improving survival. Patients at a safety-net hospital also face significant disparities in healthcare access, often due to race and other socioeconomic factors, which can have a significant role in delaying treatment. Method:This is a single-center retrospective study analyzing the relationship between time from initial CT to initiation of treatment in newly diagnosed lung cancer using the NCDB from 2015 to 2019. Delay in treatment was defined as diagnosis-to-treatment time longer than 6 weeks. CT was used as a marker of time of diagnosis. Results:150 patients were included in the study with the majority being African American (130; 87%) and having public insurance (115; 77%). 102 (68%) patients experienced a delay to treatment from CT to treatment. The overall median time to treatment was 54.5106 days (p=0.001). Time to treatment was 72.6 (SE 15.1) for chemotherapy, 70.16 (18.2) for radiation, 134.5 (14.7) for surgery, and 81.8 (21.5) for chemotherapy and radiation. This difference in delay was significant (p =0.011).
Conclusions:This study population is predominantly African American and experienced a significant delay. This delay is likely multifactorial, including socioeconomic factors of race, healthcare access, and insurance type. Further investigation into this particular population and the risk factors and variables that lead to this delay in treatment is warranted to best optimize care for this vulnerable population.

All patientsStandardDelayedP Value
Patient s, n (%)15048 (32%)102 (68%)
Sex, n (%)
Female95 (63%)26 (27%)69 (73%)
Malei55 (37%)22 (40%)33 (60%)
Race, n (%)
African American130 (87%)40 (31%)90 (69%)
White15 (10%)6 (40%)9 (60%)
Other5 (3%)2 (40%)5 (60%)
Insurance Type n(%)
Public Private None/Self Pay115 (77%) 28 (18%) 7 (5%)35 (30%) 9 (32%) 4 (57%)80 (70%)19 (68%) 3 (43%)
Median (SD) Duration (days)From CT to 1st Treatment54.5 (106)20 (12.9)54 (87.50).001
First Treatment Modality, n (%)
Chemotherapy46 (31%)13 (28%)33 (72%)
Radiation32 (21%)14 (44%)18 (56%)
Su rger y49 (33%)15 (31%)34 (69%)
Chemotherapy+
Radiation23 (15%)6 (26%)17 (74%)
Time to Pt Treatment (Days)Median (SD)
Chemotherapy54.5 (60.5)
Radiation45.5 (72.8)
Surgery76 .0 (151.6)
Chemotherapy +Radiation59.0 (73.1)
Time to Pt Treatment (Days)Estimated Marginal Means (SE)
Chemotherapy72.6 (15.1).011
Radiation70.16 (18.2)
Surgery134.5 (14.7)
Chemotherapy + Radiation81.8 (21.5)

SD = Standard DeviationSE = Standard Error
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