REAL-WORLD ANALYSIS OF TREATMENT DELAYS IN METASTATIC NON-SMALL LUNG CANCER: DEMOGRAPHIC, CLINICAL AND PAYER DRIVERS
Author(s)
Stacy Justo, MA, Meghana G. Shamsunder, PhD Epidemiology and Biostatistics, Marten van den Berg, PhD.
Norstella, New York, NY, USA.
Norstella, New York, NY, USA.
OBJECTIVES: Delays in initiating systemic therapy for metastatic non-small cell lungcancer (mNSCLC) may reflect access barriers and inefficiencies in healthcare delivery,potentially impacting outcomes.To identify demographic, clinical, and payer-related factors associated withtime to treatment initiation among patients with mNSCLC using real-world data.
METHODS: We conducted a retrospective cohort study using the NorstellaLinQ database,including U.S. closed claims and electronic medical record data from 2017 through August2025. Adults (≥18 years) newly diagnosed with mNSCLC were included if they had ≥6months of continuous enrollment prior to diagnosis and ≥3 months post-diagnosis.Patients undergoing surgical treatment were excluded. Treatment delay was defined asmonths from diagnosis to treatment initiation. Treatment included all FDA-approvedtherapies for mNSCLC except Cabozantinib. A Cox Proportional Hazard Model assessedassociations between delay and patient characteristics, including age, sex, CharlsonComorbidity Index (CCI), payer type at index treatment, and interaction terms for payer andCCI.
RESULTS: Among 7,096 patients, the mean time from diagnosis to treatment initiation was1.22 months. The Cox model estimated hazard ratios for time to treatment initiation,accounting for censoring for patients who did not initiate treatment during follow-up. Lowerhazard ratios indicate a slower rate of treatment initiation (longer delays). Highercomorbidity scores were associated with slower initiation: CCI ≥3 (HR = 0.85; p < 0.0001).Insurance type also influenced initiation rate: Medicaid patients had a 39% lower hazardcompared to commercial insurance (HR = 0.61; p < 0.0001), and Medicare Advantagepatients had a 22% lower hazard (HR = 0.78; p < 0.0001).
CONCLUSIONS: Treatment delays were longest for patients with high comorbidity (CCI ≥3) andfor those covered by Medicaid or Medicare Advantage. These findings highlight theindependent impact of clinical complexity and insurance type on timely cancer care andunderscore the need for targeted interventions to reduce administrative and coordinationbarriers.
METHODS: We conducted a retrospective cohort study using the NorstellaLinQ database,including U.S. closed claims and electronic medical record data from 2017 through August2025. Adults (≥18 years) newly diagnosed with mNSCLC were included if they had ≥6months of continuous enrollment prior to diagnosis and ≥3 months post-diagnosis.Patients undergoing surgical treatment were excluded. Treatment delay was defined asmonths from diagnosis to treatment initiation. Treatment included all FDA-approvedtherapies for mNSCLC except Cabozantinib. A Cox Proportional Hazard Model assessedassociations between delay and patient characteristics, including age, sex, CharlsonComorbidity Index (CCI), payer type at index treatment, and interaction terms for payer andCCI.
RESULTS: Among 7,096 patients, the mean time from diagnosis to treatment initiation was1.22 months. The Cox model estimated hazard ratios for time to treatment initiation,accounting for censoring for patients who did not initiate treatment during follow-up. Lowerhazard ratios indicate a slower rate of treatment initiation (longer delays). Highercomorbidity scores were associated with slower initiation: CCI ≥3 (HR = 0.85; p < 0.0001).Insurance type also influenced initiation rate: Medicaid patients had a 39% lower hazardcompared to commercial insurance (HR = 0.61; p < 0.0001), and Medicare Advantagepatients had a 22% lower hazard (HR = 0.78; p < 0.0001).
CONCLUSIONS: Treatment delays were longest for patients with high comorbidity (CCI ≥3) andfor those covered by Medicaid or Medicare Advantage. These findings highlight theindependent impact of clinical complexity and insurance type on timely cancer care andunderscore the need for targeted interventions to reduce administrative and coordinationbarriers.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD63
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology