Resource Utilization and Timeliness of Care in Patients With Incidentally Detected Lung Nodules.

BACKGROUND: Management of patients with incidental lung nodules varies widely, leading to possible disparities in patient outcomes. Here, we describe resource utilization and timeliness of care for patients with incidental nodules measuring ≥ 9 mm in size, a threshold at which multiple options exist for evaluation. We further investigated the relationship between timeliness of care and socioeconomic context by using the Neighborhood Deprivation Index. RESEARCH QUESTION: How do resource utilization and timeliness of care vary for patients with incidental lung nodules ≥ 9 mm, and how are these factors influenced by neighborhood socioeconomic deprivation? STUDY DESIGN AND METHODS: A previously validated natural language processing algorithm identified 23,789 patients within a large, vertically integrated health system (2006-2016) with incidental lung nodules ≥ 9 mm identified by chest CT scan. Utilization of imaging and invasive procedures was described, stratified by final diagnosis, and represented with Sankey plots. Timeliness of care was assessed using Kaplan-Meier curves and multivariable regression, with the Neighborhood Deprivation Index evaluated as both a categorical and continuous variable. RESULTS: Among all patients with incidentally detected nodules, 2,356 were diagnosed with lung cancer (9.9%). Overall, follow-up imaging was obtained in 60.1% of patients with benign nodules and 92.9% of patients with malignant nodules. One in 5 surgical resections, 1 in 2 percutaneous biopsies, and 2 in 3 bronchoscopies were performed in patients with benign nodules, consistent with possible overevaluation. Sankey plots revealed more complex and variable care pathways for patients with malignant nodules. A 1-SD increase in deprivation was associated with an 11% reduction in the timeliness of treatment (hazard ratio, 0.89; 95% CI, 0.81-0.97), but there was no association with time to diagnosis. INTERPRETATION: Our results show a wide variation in resource utilization and care pathways for patients with benign and malignant lung nodules. Socioeconomic deprivation was associated with increased time to cancer treatment.