Time from diagnosis to surgery for stage I non-small cell lung cancer among Native Hawaiians and other Pacific Islanders.

Abstract

e13798 Background: Surgery is the standard of care for Stage I non-small cell lung cancer (NSCLC); however, treatment among racial minority groups, particularly Native Hawaiian and other Pacific Islander (NHOPI) populations, remains underexplored. We previously reported that NHOPI patients with stage I NSCLC are treated with surgery less often than Whites. This study investigates the time from diagnosis to surgery and outcomes of NHOPI patients with stage I NSCLC. Methods: A retrospective analysis of 1,141 patients diagnosed with Stage I NSCLC at Queen’s Medical Center from 2000 to 2022 was conducted. Race was categorized as (White, Asian, NHOPI). The disparity of time from diagnosis to surgery between racial groups was assessed using univariable and multivariable models adjusted for age, gender, insurance status, site of tumor, and histology with the Cox hazarded model. Results: Among the 1,141 patients, the racial distribution included 288 White, 662 Asian, and 191 NHOPI patients. NHOPI patients were younger (p < 0.001), more likely to be uninsured/Medicaid (p < 0.001), and underwent surgery less frequently than white patients (p = 0.021). There was no significant difference in median time from diagnosis to surgery across racial groups: 51 days for Whites, 46 days for Asians, and 46 days for NHOPI patients (p = 0.46). In multivariable analysis, factors significantly associated with a longer time from diagnosis to surgery included Medicaid/uninsured status (aHR 0.65 95% CI 0.52–0.81, p < 0.001), age > 80 years (aHR 0.61 95% CI 0.46–0.80, p < 0.001), and male (aHR 0.87 95% CI 0.75–0.99, p = 0.05). Median survival times were 78.5 months for White patients, 81.7 months for Asian patients, and 69.3 months for NHOPI patients ( p = 0.43). In multivariable analysis, lower survival outcomes were associated with advanced age ( > 80 years, aHR 2.85 95%CI 1.95-4.18, p < 0.001) Medicaid/uninsured status (aHR 1.27 95% CI 1.05-1.54, p = 0.013), and squamous cell carcinoma histology (aHR 1.42 95%CI 1.18-1.72, p < 0.001). In contrast, Asian patients demonstrated better survival outcomes compared to White patients (aHR 0.77 95% CI 0.64-0.94, p = 0.010). Conclusions: We did not identify a significant difference in time to surgery or survival for NHOPI patients. However, Medicaid/uninsured status was significant to have a longer time from diagnosis to surgery for Stage I NSCLC. These disparities highlight the need for targeted interventions to improve access to and utilization of standard-of-care treatment, potentially reducing inequities in lung cancer outcomes. Univariable and multivariable analysis in time from diagnosis to surgery among stage I NSCLC patients. Univariable analysis Multivariable analysis* Race HR (95%CI) P value HR (95%CI) P value  White Reference Reference  Asian 1.17 (0.99-1.34) 0.061 1.14 (0.97-1.35) 0.115  NHOPI 0.99 (0.79-1.25) 0.957 0.94 (0.74-1.18) 0.569 Insurance  Private Reference Reference  Medicare 1.00 (0.86-1.17) 0.956 1.06 (0.90-1.24) 0.526  Medicaid/uninsured 0.74 (0.59-0.92) 0.008 0.65 (0.52-0.83) <0.001