INTRODUCTION: Healthcare system (HCS) disruptions during COVID-19 have significantly impacted cancer diagnostics and treatment management. This study examined the effects of the COVID-19 pandemic on the staging at diagnosis, initial treatment patterns, and time to treatment initiation (TTI) for non-small cell lung cancer (NSCLC), focusing on disparities across healthcare settings and demographics.

METHODS: We conducted a retrospective cohort analysis of NSCLC cases in the US National Cancer Database (2014-2022), excluding records with missing TTI or clinical stage data. Outcomes were compared before (2014-2019) and after (2021-2022) the healthcare system disruption using chi-square tests, t-tests, and interrupted time series analysis.

RESULTS: A total of 865,808 individuals were included (mean age 69; 50% female; 82% White; 73% Medicare/Medicaid). Early-stage diagnoses increased from 44% to 46% (p<0.01). Minor differences were observed in initial treatment patterns. Mean TTI increased by approximately 9 days (p<0.01), with community cancer programs showing the greatest increase (+10 days) compared to other facilities. Regional differences were also noted, with New England experiencing the highest TTI increase (+12 days). Black individuals faced longer TTIs (56 vs 51 days for White patients), though White patients experienced the greatest increased (+9 days).

CONCLUSIONS: Healthcare system disruptions due to COVID-19 were associated with delayed NSCLC diagnoses, longer treatment initiation, and persistent disparities in access to timely care. While short-term survival differences were modest, earlier treatment initiation remained associated with improved outcomes. Further research is needed to evaluate whether these delays persist and to explore their long-term consequences on patient outcomes.

POLICY SUMMARY: This evidence calls for resilience-focused oncology policies, supporting continuity plans, real-time delay monitoring, and targeted resource allocation to underserved and outpatient settings.