Graduation Date

Spring 5-5-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

KM Monirul Islam, Ph.D


Despite many significant medical advances, lung cancer continues to cause more deaths than any of the other cancers in the United States (US), and worldwide. Timeliness of care and evidence-based guidelines are among the components of quality of care that are expected to improve patient outcomes. However, evidence on the effect of timeliness of care and adoption of evidence-based guidelines on patient survival remains lacking. In addition, there has been increasing concern on the fact that smokers are not the only group that suffers from lung cancer. Never-smokers comprise at least 10% of lung cancer patients in the US, or 25% worldwide. A better understanding of outcomes among never-smoker patients is needed. Using two nationwide cancer registries, this dissertation examines the effect of extended time-to-treatment, non-adherence to treatment guidelines, and never-smoking status on the survival of lung cancer patients. The results of our study suggest the harmful effect of extending time to treatment initiation among patients diagnosed with early stage cancer and resectable lung tumor, and the survival benefit of adherence to treatment guidelines. This study also highlights the importance of ensuring never-smoker patients received molecular testing and targeted therapy since the survival benefit among never-smokers was only evident in patients diagnosed at younger than 65-years-old. Overall, the results of this dissertation could assist in improving the provision of lung cancer treatment, which would lead to improved patient outcomes.

Included in

Epidemiology Commons