ABSTRACT
Introduction: Delays in initiation of treatment for advanced cancers are associated with poorer outcomes. In advanced NSCLC, one factor impacting time of treatment initiation is next-generation sequencing (NGS) testing. In our hospital system, Northwestern Medicine, the standard for NGS testing at Northwestern Memorial, the 894-bed academic hospital, is in-house reflex testing on all histologies and stages for a 50-gene panel of mutations and fusions. At affiliate hospitals, there is no set protocol so testing is sent to private vendors. The purpose of this study was to compare time from biopsy to treatment between the academic center and two affiliate hospitals evaluating for impact of NGS testing, radiation therapy, repeat biopsies, and the COVID-19 pandemic. Methods: We queried the Northwestern Medicine Enterprise Data Warehouse for patients with a new diagnosis of lung cancer between January 1, 2019 and December 31, 2020 at Northwestern Memorial Hospital (NMH), Central DuPage Hospital (CDH), and Delnor Hospital. This yielded a total of 864 patients - 623 (72.1%) diagnosed in 2019 and 241 (27.9%) diagnosed in 2020. Inclusion criteria for analysis: new diagnosis of stage IV NSCLC with diagnostic evaluation conducted at one of the three aforementioned hospitals. Results: 191 patients with stage IV NSCLC met inclusion criteria, 68.6% (131/191) diagnosed in 2019 and 31.4% (60/191) diagnosed in 2020. 148/191 patients received systemic therapy, 102 diagnosed in 2019 (44 NMH / 58 CDH and Delnor), and 46 diagnosed in 2020 (27 NMH / 19 CDH + Delnor). 59/148 patients had radiation prior to systemic therapy (29 NMH, 30 CDH + Delnor), and 20/148 required repeat biopsy (10 NMH, 10 CDH + Delnor). Median time from first biopsy to treatment was 30 days at Northwestern and 37 days at CDH + Delnor overall;in 2019, these times were 35 days at Northwestern and 38 days at CDH + Delnor, and in 2020, these times were 26 days at Northwestern and 37 days at CDH + Delnor (Figure 1). [Formula presented] Conclusions: Time from biopsy to treatment decreased between 2019 and 2020 at Northwestern but not at CDH + Delnor, and was shorter overall at Northwestern compared with CDH + Delnor. Radiation therapy and need for repeat biopsy did not differ between the two sites, suggesting that reflex NGS may be associated with faster turnaround times. Fewer patients presented with lung cancer in 2020 than 2019, highlighting the impact of the COVID pandemic on cancer care. Keywords: NGS, Time to treatment