Time to initial cancer treatment in the United States and association with survival over time: An observational study

Abstract

Background Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. Methods and findings We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. Conclusions TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients.

Association of Medicaid Expansion Under the Affordable Care Act With Insurance Status, Cancer Stage, and Timely Treatment Among Patients With Breast, Colon, and Lung Cancer

“…The primary independent variable was an interaction between residence in a Medicaid expansion state and cancer diagnosis in the postexpansion period (2014-2016). Based on prior literature, 18,[25][26][27][28][29][30][31][32][33][34][35][36] patient-level covariates included age, sex, race/ethnicity, insurance status, income, JAMA Network Open | Health Policy educational level, rurality, distance to hospital facility, hospital transfer, Charlson-Deyo comorbidity, 37 multiple malignant neoplasms, cancer type, and stage at diagnosis. The NCDB estimates median family income and educational attainment using data from the 2016 American Community Survey linked with the patient's zip code of residence at diagnosis.…”

Cancer patients in complementary and alternative medicine: More harm

“…were associated with worsened overall survival for stages I and II breast, lung, renal, and pancreatic cancers, and stage II colorectal cancer, with increased risk of mortality of 1.2% to 3.2% per week of delay, adjusting for comorbidities and other variables 5 .…”

To Do or Not to Do?—A Review of Cancer Surgery Triage Guidelines in COVID-19 Pandemic

“…These facts cannot be overseen, also, cancer is a bigger problem than COVID-19 from patient's perspective. Table 1 summarises various studies addressing the impact of time to treatment initiation or delaying surgeries on cancer survival [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Keeping these concerns in mind, some guidelines have recommended a possible triage ( Table 2) to offer surgeries, even during the course of an active pandemic, for certain precarious malignancies who are known to have rapid progression.…”