title: Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient survival.
abstract: OBJECTIVE
  Prompt staging and treatment are crucial for non-small cell lung cancer (NSCLC). We determined if predictors of treatment delay after diagnosis were associated with prognosis.
  
  
  METHODS
  Medicare claims from 28,732 patients diagnosed with NSCLC in 2004-2007 were used to establish the diagnosis-to-treatment interval (ideally ⩽35days) and identify staging studies during that interval. Factors associated with delay were identified with multivariate logistic regression, and associations between delay and survival by stage were tested with Cox proportional hazard regression.
  
  
  RESULTS
  Median diagnosis-to-treatment interval was 27days. Receipt of PET was associated with delays (57.4% of patients with PET delayed [n=6646/11,583] versus 22.8% of those without [n=3908/17,149]; adjusted OR=4.48, 95% CI 4.23-4.74, p<0.001). Median diagnosis-to-PET interval was 15days; PET-to-clinic, 5days; and clinic-to-treatment, 12days. Diagnosis-to-treatment intervals <35days were associated with improved survival for patients with localized disease and those with distant disease surviving ⩾1year but not for patients with distant disease surviving <1year.
  
  
  CONCLUSIONS
  Delays between diagnosing and treating NSCLC are common and associated with use of PET for staging. Reducing time to treatment may improve survival for patients with manageable disease at diagnosis.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States. Electronic address: dgomez@mdanderson.org.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Gomez
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.affiliation: Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.affiliation: Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: George R
authors.initials: GR
authors.lastname: Blumenschein
authors.affiliation: Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Erasmus
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D061665:Time-to-Treatment; D014481:United States
keywords: Medicare claims; Quality of care analysis; SEER database; Timeliness of care