Association Between Waiting Time from Diagnosis to Treatment and Survival in Patients with Curable Gastric Cancer: A Population-Based Study in the Netherlands

Abstract

BackgroundIn the Netherlands, a maximum waiting time from diagnosis to treatment (WT) of 5 weeks is recommended for curative cancer treatment. This study aimed to evaluate the association between WT and overall survival (OS) in patients undergoing gastrectomy for cancer.MethodsThis nationwide study included data from patients diagnosed with curable gastric adenocarcinoma between 2005 and 2014 from the Netherlands Cancer Registry. Patients were divided into two groups: patients who received neoadjuvant therapy followed by gastrectomy, or patients who underwent gastrectomy as primary surgery. WT was analyzed as a categorical (≤5 weeks [Reference], 5–8 weeks, >8 weeks) and as a discrete variable. Multivariable Cox regression analysis was used to assess the influence of WT on OS.ResultsAmong 3778 patients, 1701 received neoadjuvant chemotherapy followed by gastrectomy, and 2077 underwent primary gastrectomy. In the neoadjuvant group, median WT to neoadjuvant treatment was 4.6 weeks (interquartile range [IQR] 3.4–6.0), and median OS was 32 months. In the surgery group, median WT to surgery was 6.0 weeks (IQR 4.3–8.4), and median OS was 25 months. For both groups, WT did not influence OS (neoadjuvant: 5–8 weeks, hazard ratio [HR] 0.82, p = 0.068; >8 weeks, HR 0.85, p = 0.354; each additional week WT, HR 0.96, p = 0.078; surgery: 5–8 weeks, HR 0.91, p = 0.175; >8 weeks, HR 0.92, p = 0.314; each additional week WT, HR 0.99, p = 0.264).ConclusionsLonger WT until the start of curative treatment for gastric cancer is not associated with worse OS. These results could help to put WT into perspective as indicator of quality of care and reassure patients with gastric cancer.

Evaluation of the Implementation of FDG-PET/CT and Staging Laparoscopy for Gastric Cancer in The Netherlands

“…27 In addition, baseline waiting times were comparable with previously reported median waiting times of 4.6 weeks to the start of neoadjuvant treatment and 6 weeks to primary surgery. 28 Performing FDG-PET/ CT or SL was associated with a significantly prolonged waiting time from diagnosis to the start of treatment, both for neoadjuvant treatment (although clinically less relevant) and primary surgical treatment. Patients undergoing primary surgery are usually older and have several comorbidities, and are therefore not deemed fit enough for chemotherapy.…”

Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery

“…Increasing time to surgery up to greater than 8 weeks in the primary gastrectomy group did not impact overall survival. 60 Furukawa et al divided the time to surgery into three groups (30-60 days, 60-90, > 90). On initial univariate analysis, early surgery was associated with worse survival; however, after multivariate adjustment, time to surgery was not an independent prognostic factor for survival.…”

Improving outcomes in gastric cancer surgery

“…They did not find a significant difference in mean length-of-stay. The implementation of a fast-track or ERAS program was also investigated as an addition to laparoscopic procedures [63][64][65]. A consecutive series of 32 patients showed that it was safe and had similar postoperative results [63].…”

“…The implementation of a fast-track or ERAS program was also investigated as an addition to laparoscopic procedures [63][64][65]. A consecutive series of 32 patients showed that it was safe and had similar postoperative results [63]. In addition, a randomized clinical trial in gastric cancer patients including 22 fast-track and 22 conventional care patients showed a shorter length of stay for fast-track patients (5 vs. 8 days, P<0.001) but no difference was noted for postoperative pain [64].…”

“…It should be considered that preoperative interventions, such as nutritional-and exercise therapy, may delay the time between diagnosis and surgery. Although no clear evidence exists that shows an adverse effect of treatment delay on survival [63][64][65]. Treatment delay can however have a clear negative impact on Quality of Life and emotional stress in cancer patients [66].…”