ObjectiveTo investigate the timing of adjuvant chemotherapy initiation after lung cancer surgery and factors associated with delayed initiation. MethodsClinical data of patients scheduled to receive platinum-based adjuvant chemotherapy after radical lung cancer surgery at the Department of Thoracic Surgery, Zhujiang Hospital, Southern Medical University, from September 2024 to December 2025 were retrospectively collected. The time to adjuvant chemotherapy was defined as the interval from surgery to the first administration of adjuvant chemotherapy. The 75th percentile of this cohort, 48 days, was used as an exploratory cutoff to divide patients into non-delayed and delayed groups. Pain, dyspnea, sleep disturbance, and fatigue were assessed using the MD Anderson Symptom Inventory from postoperative days 2 to 7, and the maximum score for each symptom was used for analysis. Firth-corrected logistic regression was used to identify factors associated with delayed initiation. ResultsA total of 61 patients were included, with a median age of 63.00 years (interquartile range, 53.00-68.00 years), and 52 (85.2%) were male. The median time to adjuvant chemotherapy was 38 days, and 17 (27.9%) patients experienced delayed initiation. Compared with the non-delayed group, the delayed group had a higher sleep disturbance score [6.0 (3.0, 7.0) vs. 4.0 (3.0, 5.0), P=0.021], and showed a trend toward a higher incidence of postoperative complications [35.3% (6/17) vs. 11.4% (5/44), P=0.058] and fatigue scores [5.0 (3.0, 6.0) vs. 3.5 (2.0, 5.0), P=0.076]. Multivariable analysis showed that postoperative complications were independently associated with delayed initiation [aOR=4.27, 95%CI (1.05, 18.85), P=0.042]. ConclusionManagement and timely intervention of postoperative complications are essential for facilitating the timely transition to adjuvant chemotherapy, and early postoperative symptom monitoring may help optimize perioperative management and promote the scheduled continuation of subsequent treatment.