Health-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.
We 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.
Among 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  vs. 67 , 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).
The 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.
- • Population-based cohort study of adult patients with mNSCLC (2017–2018).
- • 79% initiated first-line treatment.
- • Untreated patients more likely to be older, sicker, smokers and hospitalized.
- • Time from initial symptom to imaging was longer for untreated than treated patients.
- • Median time from first symptom to initiation of 1 L was 7.76 months
Lung cancer is associated with mortality, morbidity and poor quality of life, and is one of the most difficult cancers for primary care physicians to diagnose due to few early symptoms and patient delay in seeking care . Non-small cell lung cancer (NSCLC) accounts for approximately 85–90% of all lung cancer with a 5-year survival rate of 22.1%. A total of 70% of NSCLC patients are diagnosed with advanced (stage IIIB or IV) disease which is associated with significantly worse survival .
Factors affecting prognosis include stage and performance status at diagnosis, co-morbidity, age, sex and the time interval between first symptom and treatment . The current process of new cancer diagnosis is associated with a stressful diagnostic process which includes waiting times for imaging procedures, pathological assessments and specialists’ visits. Waiting for these tests may lead to disease progression, impact treatment decisions and negatively affect outcomes . One study found that 38% of all patients with metastatic lung cancer died within 2 months of diagnosis, with 93% of these deaths being attributed to the diagnosed cancer .