All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Larry Hearld

Bisakha Sen

Vamsidhar Velcheti

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


The COVID-19 pandemic has derailed normal operations in the health care delivery systems in the United States (US) and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess time to treatment initiation (TTI) with systemic cancer therapy in patients with newly diagnosed metastatic lung cancer, metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. The retrospective claims study included patients greater than 18 years of age with commercial, commercial self-pay, and Medicare Advantage insurance. Analyses were conducted from January 1, 2019 to February 29, 2020, pre-pandemic period, and compared to March 1, 2020 to April 30, 2021, the pandemic/post-pandemic period. Cox proportional hazards models were used to describe and investigate the difference in TTI in pre-pandemic and pandemic/post-pandemic time periods. Multivariable logistic regression models were used to assess the probability of having a hospital, ER or hospice/palliative care visit. Multivariable linear regression models were used to see differences in the utilization of outpatient visits. Multivariable Generalized Linear Models with a log transformation and gamma distribution were used iv to see if there were differences in healthcare costs. There was no difference in TTI between the pre-pandemic and pandemic/post-pandemic time periods. The odds of receiving outpatient and inpatient hospice/palliative care, inpatient and ER care were lower in the pandemic/post-pandemic period. Per patient per month (PPPM) metastatic lung cancer-related and total costs were higher in the pandemic/post-pandemic time period. This is the first study assessing the impact of the COVID-19 pandemic on TTI, HCRU and costs in patients with newly diagnosed metastatic lung cancer.



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