Factors associated with delays in care of suspicious lung nodules at an academic medical center.

e13705 Background: Shorter time to lung cancer diagnosis and treatment are associated with improved outcomes. Here, we assessed factors contributing to delays in each phase of care to identify targets for improving the timeliness of suspicious lung nodule care in a diverse patient population. Methods: We conducted a retrospective study of patients evaluated for suspicious lung nodules at an academic medical center from 2020 to 2022. Patients with presumed or proven stage I/II lung cancer were included. Patients with stage III/IV and non-primary lung cancers were excluded. Multivariable Cox regressions were performed. Results: Of 157 patients, mean age was 70±8.6 years, 59% were female, and 53% were Black. Most lung nodules were biopsied bronchoscopically (61%) or surgically (26%). Most (83%) nodules were stage I/II non-small cell lung cancer, 10.2% were benign and 4.4% were other. Treatment was surgery in 48% and stereotactic body radiotherapy (SBRT) in 41%. Median intervals were 4 (IQR 0-18) days from nodule identification to referral, 7 (IQR 3-14) days from referral to consultation, 20 (IQR 12-34) days from consultation to biopsy, 4 (IQR 2-6) days from biopsy to diagnosis, and 28 (IQR 8-43) days from diagnosis to treatment initiation. Multivariable Cox regression showed that longer time from referral to diagnosis (TTD) was associated with Black race, widowed status, and referral > 1 year from the start of the COVID-19 pandemic. Longer time from referral to treatment (TTT) was associated with female gender, widowed status, 4th Area Deprivation Index (ADI) quartile, frailty, BMI > 18.5, ECOG performance status 12.5 miles from the hospital. Longer time from diagnosis to treatment was associated with Medicaid, referral > 1 year from the start of the pandemic, cardiovascular disease, and SBRT. Conclusions: The longest delays in lung nodule care are associated with time from consultation to biopsy and from diagnosis to treatment. Efforts to address disparities and modifiable factors could improve the timeliness of care for patients with suspicious lung nodules. Table: see text