A new study suggests patients who recover slowly from non-small-cell lung cancer (NSCLC) surgery may still benefit from delayed chemotherapy started up to four months after surgery, according to a new study published online by JAMA Oncology.

Adjuvant chemotherapy after initial cancer surgery has become a standard recommendation for patients with NSCLC with lymph node metastases, tumors that are four centimeters or larger or extensive local invasion of the cancer. While there is consensus regarding indications for chemotherapy after the initial cancer treatment, the optimal timing following surgical resection is poorly defined. Many clinicians support starting chemotherapy within six weeks after surgery. But factors such as postoperative complications may affect a patient’s ability to tolerate chemotherapy.

Daniel J. Boffa, MD, of the Yale School of Medicine, New Haven, Conn., and coauthors used data from patients in the National Cancer Database to examine the relationship between the timing of postoperative chemotherapy and five-year mortality.

The study of 12,473 patients with stage I, II or III disease who received multi-agent chemotherapy suggests that later chemotherapy (57 to 127 postoperatively) was not associated with increased risk of death and later chemotherapy also was associated with a lower risk of death compared with those patients treated only with surgery, according to the results.

Limitations of the study include that it cannot establish causality.

“Patients with completely resected NSCLC in the NCDB [National Cancer Database] continue to benefit from adjuvant chemotherapy when given outside the traditional postoperative window. Clinicians should still consider chemotherapy in appropriately selected patients that are healthy enough to tolerate it, up to four months after NSCLC resection. Further study is warranted to confirm these findings,” the article concludes.