Background: The prognosis of eNSCLC remains uniformly poor. An understanding of current therapies and outcomes can provide insights into how novel therapies can be integrated into our management paradigm. Methods: We conducted a large, retrospective, population-based cohort study of de novo eNSCLC patients (stages IB, IIA, IIB, and IIIA) diagnosed in Alberta, Canada between 2010-2019 using electronic medical records and administrative claims data. The primary objectives were to describe treatment patterns and survival outcomes among eNSCLC patients. In addition, we examined the association between systemic therapy (ST) and overall survival (OS) using multivariable Cox proportional hazards models. Results: A total of 5,126 eNSCLC patients were included. The stage distributions were: 31.0% IB, 13.4% IIA, 17.7% IIB, and 37.9% IIIA. The mean (SD) age was 71.3 (10.3) years and 52.5% were female. 45.3% of patients were referred to a medical oncologist, ranging from 23.7% in stage IB and 58.3% of IIIA. Among stage IB and II patients, 59.2% and 58.1% received surgery, respectively, while 25.7% of stage IIIA patients underwent surgery. 23.6% of patients initiated ST, ranging from 3.5% in stage IB to 38.5% in IIIA. ST use increased over the study period by 9.3% and 19.5% in stage IIB and IIIA disease, respectively. Median follow-up for the cohort was 21.86 months; median OS was 28.18 months (95% CI: 26.56-29.69). Median OS for stage IB, IIA, IIB, and IIIA were 49.01 (95% CI: 45.00-54.15), 36.56 (95% CI: 32.94-42.25), 29.23 (95% CI: 25.32-33.11), and 16.50 (95% CI: 15.39-17.59). Findings from the Cox analyses are tabulated (see Table). For stage IIB and IIIA individuals who received surgery, adjuvant ST was also associated with a decreased likelihood of death [hazard ratios (HR) of 0.77 (95% CI: 0.56-1.07) and 0.69 (95% CI: 0.54-0.89), respectively]. Conclusions: In a Canadian real-world setting, stage IIB and IIIA patients who received adjuvant ST tended to have better survival than patients who did not. However, a considerable proportion of patients are not referred to a medical oncologist to be considered for ST. Improving referral pathways appears to be an essential step to ensure that emerging novel therapies are implemented effectively in the real world so that potential survival gains from new drugs can be realized.

*Model also included neighbourhood income, education, and rural residence