Presentation (CTI)

OBJECTIVES: This retrospective cohort study investigates disparities in time from diagnosis to curative-intent surgery based on socioeconomic status (SES) among U.S. adults with early-stage non-small cell lung cancer (NSCLC), where evidence suggests socioeconomic factors affect surgical timing.
METHODS: Using Flatiron Early NSCLC Enhanced Datamart data, we analyzed 363 adult patients diagnosed with Stage I or II NSCLC between 2019-2025. All patients had SES data classified using Yost Index quintiles (Q1=lowest, Q5=highest), incorporating variables such as household income and unemployment levels. The primary outcome was time from diagnosis to curative-intent surgery. Eighty-four patients (23.1%) underwent surgery. Time to surgery was examined using Kaplan-Meier estimates and multivariable Cox regression adjusting for clinical and demographic factors, with stratification addressing proportional hazards violations.
RESULTS: The cohort, consisting of 363 patients (mean age 72.5 years, 54.5% female, 84.8% White, 56.4% public insurance, 90.4% smoking history) demonstrated significant SES disparities in surgical timing. Multivariable Cox regression determined that compared to Q1, higher SES quintiles had progressively faster surgery: Q2 (HR=2.45, p=0.030), Q3 (HR=2.79, p=0.012), Q4 (HR=2.61, p=0.026), Q5 (HR=3.53, p=0.002). Additional significant predictors included age (HR=0.93 per year, p<0.001), with older patients experiencing delays; geographic region, with South (HR=0.39, p=0.001) and West (HR=0.41, p=0.044) showing slower surgical timing; smoking status, with never-smokers receiving faster surgery (HR=3.51, p<0.001); and advanced clinical stage IIB (HR=0.35, p=0.004).
CONCLUSIONS: Significant SES gradients persist in time to curative-intent surgery for early-stage NSCLC, with age, geographic region, smoking status, and clinical stage also influencing surgical timing. These findings highlight persistent socioeconomic and geographic disparities in access to timely surgical care.