Delays in Early-Stage NSCLC Surgery Linked to Systemic and Equity Gaps in Patients
Key Takeaways:
- Surgical delays are common and clinically significant: More than half of patients (54%) did not receive surgery within 8 weeks of diagnosis as is recommended. Timeliness should be treated as a core quality metric, not a secondary consideration.
- Racial and geographic disparities persist—even in integrated systems: Black and Asian patients, as well as those living more than 50 miles from surgical centers, faced significantly higher risks of delayed care. These inequities point to systemic access barriers that coverage policies and care models must actively address.
- More care does not equal faster care: Higher health care utilization (≥25 visits) was strongly associated with delays, suggesting inefficiencies, fragmentation, or administrative burden rather than improved coordination.
- Delays are cumulative across the care pathway—not driven by 1 step: No single diagnostic or preoperative step caused delays. Instead, each step (imaging, biopsy, testing, consults) took longer in delayed cases, highlighting the need for end-to-end workflow optimization rather than isolated fixes.
Timely treatment remains an underprioritized dimension of health care quality, and new research underscores its critical importance in early-stage non–small cell lung cancer (NSCLC). A large, integrated health system analysis of 2567 patients found that more than half (54%) experienced surgical delays beyond the recommended 8-week window from diagnosis—and these delays are linked to worse survival outcomes.
The findings in this study highlight a complex interplay of patient-level and process-level factors contributing to delayed care and raise important implications for payers, managed care organizations, and health systems aiming to optimize oncology pathways and outcomes.
The study identified several independent predictors of delayed surgery. Black and Asian patients were each 14% more likely to experience delays compared with White patients. Geographic access also played a significant role: patients living more than 50 miles from a surgical facility had a 23% higher risk of delay.
Health care utilization emerged as another major driver. Patients with 25 or more clinical encounters prior to surgery were 72% more likely to experience delays, suggesting that increased system interaction may reflect inefficiencies rather than improved coordination.
The study also examined preoperative workflows, including imaging, biopsy, pulmonary function tests (PFTs), and surgical consultation. While more steps were associated with longer overall time to surgery, no single step was identified as the primary bottleneck.
Instead, delays appeared to be cumulative. Patients who ultimately experienced delayed surgery were found to also experience delays in preoperative steps, suggesting inefficiencies across the entire care pathway rather than isolated failures.
For payers and managed care stakeholders, the findings point to several actionable considerations:
- Establish timeliness metrics: Incorporate diagnosis-to-treatment intervals into quality measures and value-based contracts. The study supports an 8-week benchmark for surgical intervention.
- Streamline preauthorization and care pathways: Administrative delays, including prior authorization, should be minimized or automated for high-probability cancer cases to avoid unnecessary lag.
- Support care navigation programs: High-risk patients—particularly those with socioeconomic barriers or long travel distances—may benefit from targeted navigation and logistical support.
- Encourage step consolidation: Combining diagnostic procedures (eg, simultaneous biopsy and staging) and reducing redundant testing can shorten timelines without compromising care quality.
- Leverage data integration: Closed-system insights demonstrate the value of unified data. Payers should prioritize interoperability and longitudinal tracking across providers.
As cancer care becomes increasingly complex and multidisciplinary, delays may inadvertently increase without deliberate system design. The study’s authors emphasize that timeliness must be treated as a core quality domain alongside safety and effectiveness. “Our results…indicate several patient- and process-level factors contribute to delays that can be mitigated and offer preliminary benchmarks to promote timely NSCLC management,” wrote the authors.
With lung cancer screening expanding and care pathways growing more intricate, establishing clear, enforceable timeliness standards will be essential. For payers and providers alike, the message is clear: improving outcomes in early-stage NSCLC requires not just better treatments—but faster, more equitable access to them.
Reference
Tupper HI, Bhattacharjee J, Sarovar V, et al. Achieving timely treatment for early-stage non–small cell lung cancer: factors associated with delayed surgical resection and proposed quality benchmarks. JTCVS Open. 2026. doi:10.1016/j.xjon.2026.101682
