Predictors of treatment initiation and mapping the cancer diagnostic pathway: A retrospective observational cohort study of patients with metastatic non-small cell lung cancer |
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| Affiliation: | 1. Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, HaMered 27, Tel Aviv, 68125, Israel;2. MSD Israel, Merck Sharp & Dohme (Israel-1996) Company Ltd. 34 Hacharash St. P.O.B 7340, Hod Hasharon 45240, Israel;3. Institute of Oncology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel;4. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel;5. Sackler Faculty of Medicine, Tel Aviv University, Israel;1. Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany;2. School of Public Health, Department of Epidemiology, Boston University, Boston, USA;3. Cancer Registry of North Rhine-Westphalia, Bochum, Germany;4. Saarland Cancer Registry, Saarbrücken, Germany;5. CaritasKlinikum Saarbrücken St. Theresia, Saarbrücken, Germany;1. Department of Medicine, University of Chicago, Chicago, IL;2. International Prevention Research Institute, Lyon, France;1. Faculty of Medicine, University of Iceland, Reykjavik, Iceland;2. Department of Pathology, Landspitali University Hospital of Iceland, Reykjavik, Iceland;3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landspitali University Hospital of Iceland, Reykjavik, Iceland;1. Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka Prefecture 541-8567, Japan;2. Inequalities in Cancer Outcome Network, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom;1. Cancer Control Office, King Hussein Cancer Center, Amman 11941, Jordan;2. Section of Pulmonary and Critical Care, Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan;3. Pharmacy Student, University of Jordan, Amman 11972, Jordan;4. Volunteer Research Program at King Hussein Cancer Center, Amman 11941, Jordan;5. Medical Student, University of Jordan, Amman 11972, Jordan;1. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands;2. Comprehensive Cancer Centre, Eindhoven, The Netherlands;3. Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands;4. Department of Surgery, Maastricht University Medical Centre, The Netherlands;5. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands |
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| Abstract: | BackgroundHealth-care providers in the US revealed that a substantial proportion of mNSCLC patients do not receive any first-line therapy and the biggest gaps in care are time inefficiencies in the diagnostic process. The goal of this study was to determine whether such gaps are found in Israel where healthcare is universal and participation in a medical insurance plan is free and compulsory.MethodsWe conducted a retrospective, observational cohort study using the computerized data of Maccabi Healthcare Services, a 2.5 million-member state-mandated health-service. Patients with mNSCLC diagnosed between 2017 and 2018 were followed until December 2019.ResultsAmong 434 patients (62% male, mean age 68 y, 74% adenocarcinoma), 345 (79%) initiated first-line treatment. Compared to treated, untreated patients (n = 89) were more likely to be older (mean [SD]=71 years [10] vs. 67 [10], p < 0.001), have a higher co-morbidity index (5.6 ([4.4] vs. 4.0 [3.4], p < 0.001), smokers (84% vs. 66%, p = 0.001), and require hospitalization in the year prior to diagnosis (80% vs 61%, p = 0.002). There was no difference in socioeconomic status. Time from first symptom to imaging was longer for untreated than treated patients (6.51 months [4.24, 7.33] vs 3.48 months [2.76, 4.34] respectively, p = 0.22). Predictors of treatment initiation included age< 70 years, non-smokers, EGFR testing performed, ECOG performance status 0–1 and shorter wait from first symptom to imaging. Median time from first symptom to initiation of 1 L, was 7.76 months (6.51–8.75).ConclusionThe proportion of untreated mNSCLC patients are comparable to those reported in the US; we did not find health disparities between socioeconomic levels. Our data suggest that the main barrier to effective diagnostic process is the wait between symptom complaint and imaging. |
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| Keywords: | NSCLC Diagnostic pathway Predictors of treatment |
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