Delaying lung cancer surgery increase the risk of recurrence and mortality

Patients who undergo operation within 12 weeks of diagnosis fare better.


Lung cancer Is the second most common type of cancer. Swiftness is essential when treating lung cancer. Sometimes, surgical removal of a tumor-infested lung or a smaller lung section may be the only treatment that becomes handy.

However, some patients postpone the surgery while seeking a second opinion. Here, social and economic factors play a vital role.

A new work by the Washington University School of Medicine in St. Louis has now suggested that delaying surgery for more than 12 weeks from the date of diagnosis could increase the risk of recurrence and death.

The study’s senior author, Varun Puri, MD, a thoracic surgeon and professor of surgery, said, “Patients with early-stage cancer have the best chance for survival. That’s why it’s critical for patients to promptly seek treatment within 12 weeks after they’ve been diagnosed.”

“Our data provide particularly timely information regarding delayed medical care, a common issue during the ongoing global pandemic. Physicians and patients want to know more about the safety of delaying surgery. The risks have been poorly understood because previous studies have used imprecise definitions for the date of a cancer diagnosis. The goal of our study was to provide more consistent data, which we did by tracking patients from most recent CT scan diagnosis to day of surgery.”

“Pandemic fears and conflicting research about delaying surgery made it difficult to counsel patients about treatment options. Even in non-pandemic periods, the wide range of estimates about when to delay treatment can be confusing.”

“Patients need to know that COVID-19 transmission rates have been low in hospitals, particularly with screenings and mandatory protocols. As long as those are followed, hospitals are perfectly safe.”

For the study, scientists studied the U.S. Veterans Health Administration data, the nation’s largest integrated healthcare delivery system. They examined the data of 9,904 patients with stage 1 non-small cell lung cancer who underwent surgery from October 2006 through September 2016.

The study’s first author, Brendan Heiden, MD, a surgical resident and research fellow at Washington University, said“While the patient demographics may not be uniformly comparable to the overall U.S. population, the general patterns of lung cancer care and health outcomes are similar between veterans and nonveterans. This means our findings are very likely to be relevant for the broad population of early-stage lung cancer patients.”

Through this study, scientists defined the time of surgery as the period between the patient’s most recent CT scan.

Seventy percent of patients underwent surgery within 12 weeks. Such patients span lived 7.5 months longer than those who did not — 76.1 months compared with 68.6 months.

Scientists detected recurrence in 4,158 (42%) patients during the study’s follow-up period six years after surgery. Recurrence was more likely to be found in patients who delayed surgery.

Scientists noted, “for each week of delay, the risk of recurrence increased, although modestly.”

“The data indicated surgical delays were more likely in Black patients than in white patients. They plan to continue research into racial disparities and other aspects of surgical delays.”

Journal Reference:

  1. Heiden BT, Eaton Jr. DB, Engelhardt KE, Chang S, Yan Y, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Analysis of Delayed Surgery and Oncologic Outcomes in Clinical Stage I Non-small Cell Lung Cancer. JAMA Network Open, 2021. DOI: 10.1001/jamanetworkopen.2021.11613


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