A time-to-treatment initiation analysis for treatment-naive early-stage resectable non-small cell lung cancer patients in the Malaysian private healthcare sector.

INTRODUCTION

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality in Malaysia, with 95% of cases diagnosed at advanced stages. Beyond screening for early detection, timely intervention is critical for optimal outcomes in early-stage, resectable NSCLC (e-NSCLC). Delays in the diagnostic, staging and referral pathway, measured as time-to-treatment initiation (TTI), are associated with poorer survival. This contemporary realworld study is the first to evaluate TTI in a cohort of Malaysian patients with e-NSCLC.

MATERIALS AND

METHODS

This is a retrospective study of 124 consecutive treatment-naive e-NSCLC patients who had a minimally invasive curative anatomical lung resection (lobectomy or segmentectomy) and systematic mediastinal nodal dissection between January 2021 and December 2024 at two tertiary private hospitals. Medical records were reviewed to capture key timepoints across three phases of care. The primary analysis (n=124) focused on demographics and assessed the timeline from initial general practitioner (GP) to specialist consultation, diagnosis, and definitive surgery. These patients were evaluated after surgical discharge to validation of histopathology and nextgeneration sequencing (NGS) reports, and oncology review. Patients who received adjuvant therapy were included in a secondary analysis to examine timelines from NGS report validation and oncology review to initiation of adjuvant therapy.

RESULTS

The median time from the GP referral to surgery was 30.0 ± 24.5 days; GP consultation to specialist referral took 7.5 ± 17.0 days, specialist review to surgeon consultation took another 10.0 ± 16.3 days. Biopsy and staging PET-CT were completed within 3.0 ± 20.9 and 3.0 ± 20.5 days, respectively, from the initial specialist consultation. Definitive curative-intent surgery was performed 7.5 ± 13.1 days from the first cardiothoracic surgical consult and 18 ± 23.3 days following a confirmed histological diagnosis of NSCLC. The median interval from specialist review to definitive surgery was 20.0 ± 20.2 days. The median time from surgery to discharge and reporting of NGS results was 5.0 ± 2.6 days and 12.0 ± 7.7 days, respectively. Patients were seen at the first post-surgical review within 7.0 ± 3.7 days following discharge, while oncology review occurred at 19.0 ± 16.2 days post-surgery. For patients eligible for adjuvant therapy, treatment commenced 14.5 ± 11.4 days following the oncology review.

CONCLUSION

TTI is known to prognosticate recurrence-free and overall survival for e-NSCLC. This contemporary realworld experience from two leading tertiary cancer centres demonstrates the agility and efficiency of Malaysian private healthcare for prompt diagnosis, meticulous staging and timely, curative-intent definitive surgery for e-NSCLC, aligning with global benchmarks. Our study suggests, if prioritised, a swift TTI is highly achievable with appropriate expertise and coordinated resources, and should be incorporated as a deliverable national quality metric to drive improved outcomes for potentially curable e-NSCLC.