Cancer: A medical emergency

Harless, William; Qiu, Yang

doi:10.1016/j.mehy.2006.04.032

Cited by 29 publications

(24 citation statements)

References 29 publications

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“…1,2 Because doubling time for growth of detectable early-stage lung tumors is approximately 4 months, 3 timely surgery is all the more important, although studies thus far have yielded mixed survival results, perhaps because studies to date evaluated patients with both early- and late-stage non-small cell lung cancer. 4,5 Thus, findings may be due in part to a “rush to treatment” for those with the worst symptoms 6 or “treatment delay” for the sickest, 7,8 who undergo additional pre-surgery examination.…”

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confidence: 99%

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Kanarek

Hooker

Mathieu

et al. 2014

The American Journal of Medicine

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BACKGROUND “Rush to surgery” among patients with worse symptoms, delays related to morbidity, and inclusion of patients with advanced disease in study populations have produced a mixed picture of importance of time to treatment to survival of non-small cell lung cancer. Our objective was to assess the contribution of diagnosis to first surgery interval to survival among patients diagnosed in the community with early-stage non-small cell lung cancer. METHODS Patients with early-stage lung cancer (N = 174) at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins who were diagnosed and treated from 2003 to 2009 and followed through 2011 made up a prospective study of overall survival. Diagnosis to first surgery interval was examined overall, as 2 segments (referral interval and treatment interval), as short and longer intervals, and as a continuous variable. RESULTS The majority of patients were female (55%) and aged more than 65 years (61%). The average mean referral and treatment delays were 61.2 and 5.9 days, respectively. Cox method hazard analysis revealed that older age (years) at diagnosis (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00–1.05), stage UB (HR, 2.17; 95% CI, 1.12–4.21), large (>4 cm) (HR, 3.68; 95% CI, 1.05–12.93) or unknown tumor size (HR, 4.45; 95% CI, 1.21–16.38), and weeks from diagnosis to first surgery interval (HR, 1.04; 95% CI, 1.00–1.09) predicted worse overall survival. The threshold period of less than 42 days from diagnosis to surgery did not reach statistical significance. CONCLUSIONS Patients seem to benefit from rapid reduction of tumor burden with surgery. Reasons for delay were not available. Nevertheless, referral delay experienced in the community is unduly long. In addition to patient choices, an unconscious patient or physician bias that lung cancer is untreatable or an inevitable consequence of smoking may be operating and needs further investigation.

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confidence: 99%

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Kanarek

Hooker

Mathieu

et al. 2014

The American Journal of Medicine

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“…9 In a published model, the likelihood of curing micrometastatic cancer, after resection of the primary tumor, is inversely proportional to the tumor burden that must be eradicated, and hence is also inversely proportional to the time from surgery to commencement of adjuvant therapy. 10 This model, using empirical data from lung cancer, suggests that the opportunity of eradicating micrometastases virtually disappears by 100 days postsurgery.…”

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confidence: 99%

“…10 There is evidence in breast cancer that delayed adjuvant chemotherapy leads to inferior outcomes. 11,12 Published results from a recent meta-analysis of adjuvant chemotherapy in colorectal cancer, which includes some of our preliminary results, found that commencement of adjuvant treatment beyond 8 weeks was associated with an inferior survival (relative risk of death 1.20, 95% CI 1.15-1.26).…”

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confidence: 99%

Adjuvant Chemotherapy for Stage III Colon Cancer: Does Timing Matter?

Czaykowski

Gill

Kennecke

et al. 2011

Diseases of the Colon &Amp; Rectum

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“…It is indicated by a classic mathematical model that drug resistance may increase the mutation rate (23). Furthermore, the effect of chemotherapy regimens is inversely proportional to the tumor burden, suggesting that delayed initiation of AC might stimulate tumor growth (24). …”

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confidence: 99%

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

Liu

Zhai

et al. 2017

Chinese Journal of Cancer Research

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ObjectiveAdjuvant chemotherapy (AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer (NSCLC); however, few studies have reported the correlation between the time to initiation of AC (TTAC) and survival in NSCLC patients.MethodsThe clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed. TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival (DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching (PSM) was performed for survival analysis using the match data.ResultsThe optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A (≤35 d) and group B (>35 d). There was no significant difference in the DFS between the two groups (P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs (P=0.283).ConclusionsThere was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.

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Cancer: A medical emergency

Cited by 29 publications

References 29 publications

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Survival After Community Diagnosis of Early-stage Non-small Cell Lung Cancer

Adjuvant Chemotherapy for Stage III Colon Cancer: Does Timing Matter?

Is there an optimal time to initiate adjuvant chemotherapy to predict benefit of survival in non-small cell lung cancer?

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