Sex-Based Disparities in Interval Time to Receipt of Surgical Treatment of Invasive Lung Cancer in Tennessee

Why It Matters

Prolonged surgical wait times diminish survival prospects, so demographic delays directly affect patient outcomes and health equity. Addressing the identified gaps can improve lung cancer survival rates and align care with value‑based objectives.

Key Takeaways

• Men experience longer surgical wait times than women
• Older women face fewer delays; men do not
• Black patients less likely to delay surgery
• Married patients more likely to postpone surgery
• Public insurance increases risk of delayed treatment

Pulse Analysis

The interval between diagnosis and definitive surgery is a critical determinant of outcomes for patients with invasive lung cancer. Numerous studies have linked prolonged wait times to reduced overall survival and higher recurrence rates, prompting health systems to monitor surgical timelines closely. However, the distribution of these intervals is not uniform across demographic groups, raising concerns about equity in cancer care. Understanding which populations are systematically delayed can inform targeted quality‑improvement initiatives and align with value‑based care objectives. Hospitals that benchmark their median time-to-surgery against national standards can identify outliers and allocate resources accordingly.

The Tennessee Cancer Registry analysis of 12,113 patients diagnosed between 2005 and 2015 revealed several consistent patterns. Men experienced longer intervals to surgery than women, while older women showed a decreasing risk of delay, a trend not observed in men. Black patients were paradoxically less likely to postpone treatment compared with White patients. Married individuals, residents of the Appalachian region, and those covered by public insurance faced higher odds of delayed surgery, suggesting that social support structures and geographic barriers may influence scheduling and referral processes. Insurance type emerged as a strong predictor, with public payers associated with a 30% higher hazard of delay, highlighting systemic reimbursement hurdles.

These findings underscore the need for precision‑targeted interventions. Health systems should prioritize expedited pathways for male, married, and Appalachian patients, and reassess referral networks for publicly insured individuals. Policymakers might consider incentivizing rapid multidisciplinary coordination and expanding tele‑health triage in underserved regions. Implementing patient navigation programs that address logistical barriers has shown promise in other oncology settings and could be adapted for lung cancer pathways. Further research could explore underlying mechanisms—such as provider bias, transportation challenges, or insurance authorization delays—to design evidence‑based solutions that close the gap and improve survival outcomes across all demographic groups.