In patients with advanced lung adenocarcinoma and squamous cell carcinoma survival not impacted by 3-4 months treatment delay

For patients with stage III-IV adenocarcinoma and squamous cell carcinoma, an extended treatment delay of 3-4 months is not associated with significantly decreased overall survival when compared to prompt treatment, a recent analysis published in the journal Clinical Lung Cancer has suggested.

During the COVID-19 pandemic, hospitals may postpone elective surgeries and cancer operations or delay systemic cancer treatment to preserve limited resources and decrease the risk of nosocomial transmission.

Given current trajectories, experts predict that the development of even more infectious, deadly variants might ensue. Patients with lung cancer have significantly greater SARS-CoV-2 infection risk and that supportive chemotherapy may worsen that risk.

Therefore patients with stage IV NSCLC may, in conversation with their physician, be recommended to delay care or independently postpone cancer treatment.

The study conducted by Nicholas R.Mayne et. al tried to use data from the National Lung Screening Trial (NLST) and the U.S. National Cancer Data Base (NCDB) to characterize the impact of extended delays in treatment for stage III-IV NSCLC on survival.

Using National Lung Screening Trial (NLST) and National Cancer Data Base (NCDB) data, Cox regression analysis with penalized smoothing splines was performed to examine the association between treatment delay and all-cause mortality for stage III-IV lung adenocarcinoma and squamous cell carcinoma. In the NCDB, propensity score-matched analysis was used to compare cumulative survival in patients who received "early" versus "delayed" treatment (i.e., 0-30 versus 90-120 days following diagnosis).

The findings of the study are stated below:

1. Cox regression analysis of the NLST and NCDB cohorts showed a decrease in hazard ratio the longer treatment was delayed.

2. No significant differences in survival were found between early and delayed treatment for patients with stage IIIA, IIIB, IIIC, and IV adenocarcinoma and patients with IIIA, IIIB, IIIC, and IV squamous cell carcinoma in propensity score-matched analysis.

3. For patients with stage IIIB and stage IV adenocarcinoma, delayed treatment was associated with improved survival.

"The results from this national analysis demonstrate that extended delay to treatment, by 3-4 months, of advanced-stage lung adenocarcinoma and squamous cell carcinoma is not associated with worse overall survival. These findings can be used to provide reassurance to patients with stage III-IV disease who are unable to receive immediate care in areas of substantial SARS-CoV-2 transmission and to guide decision-making for administrators and public health officials during the ongoing COVID-19 pandemic and other future pandemic waves," the authors concluded.