Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review.

BACKGROUND

National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care.

METHODS

Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis.

RESULTS

Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease.

CONCLUSION

There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.

Informations de copyright

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: This project has received funding from a CRUK Early Diagnosis Advisory Group (EDAG) project award, C11558/A25623. SG is supported by funding from CRUK project award C11558/A25623. TR is funded by a National Institute for Health Research (NIHR) Doctoral Research Fellowship (ref: DRF-2016-09-054), and was previously supported by a Royal Marsden Partners (RMP) Research Fellowship. NN is supported by an MRC Clinical Academic Research Partnership (MR/T02481X/1). SMJ and HH are supported by a grant from GRAIL Inc for work on the SUMMIT study. SMJ has received funding from Jansen and fees from Bard1, Takeda and Astra Zeneca, outside of the submitted work. MDP has received lecture fees for Astra Zeneca, outside of the submitted work. NN has received fees or non-financial support from Amgen, Astra Zeneca, Bristol-Meyers Squibb, Lilly & Co, Merck Sharp and Dohme, Olympus, Oncimmune, OncLive, PeerVoice, Pfizer and Takeda, outside of the submitted work.