Waiting Time from Diagnosis to Treatment has no Impact on Survival in Patients with Esophageal Cancer

Abstract

BackgroundWaiting time from diagnosis to treatment has emerged as an important quality indicator in cancer care. This study was designed to determine the impact of waiting time on long-term outcome of patients with esophageal cancer who are treated with neoadjuvant therapy followed by surgery or primary surgery.MethodsPatients who underwent esophagectomy for esophageal cancer at the University Medical Center Utrecht between 2003 and 2014 were included. Patients treated with neoadjuvant therapy followed by surgery and treated with primary surgery were separately analyzed. The influence of waiting time on survival was analyzed using Cox proportional hazard analyses. Kaplan–Meier curves for short (<8 weeks) and long (≥8 weeks) waiting times were constructed.ResultsA total of 351 patients were included; 214 received neoadjuvant treatment, and 137 underwent primary surgery. In the neoadjuvant group, the waiting time had no impact on disease-free survival (DFS) [hazard ratio (HR) 0.96, 95 % confidence interval (CI) 0.88–1.04; p = 0.312] or overall survival (OS) (HR 0.96, 95 % CI 0.88–1.05; p = 0.372). Accordingly, no differences were found between neoadjuvantly treated patients with waiting times of <8 and ≥8 weeks in terms of DFS (p = 0.506) and OS (p = 0.693). In the primary surgery group, the waiting time had no impact on DFS (HR 1.03, 95 % CI 0.95–1.12; p = 0.443) or OS (HR 1.06, 95 % CI 0.99–1.13; p = 0.108). Waiting times of <8 weeks versus ≥8 weeks did not result in differences regarding DFS (p = 0.884) or OS (p = 0.374).ConclusionsIn esophageal cancer patients treated with curative intent by either neoadjuvant therapy followed by surgery or primary surgery, waiting time from diagnosis to treatment has no impact on long-term outcome.

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

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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.…”

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

“…For patients with locally advanced esophageal cancer, neoadjuvant chemoradiotherapy followed by esophagectomy can achieve a 5-year survival rate of approximately 40-50% (1)(2)(3). However, esophagectomy is traditionally associated with considerable postoperative morbidity and mortality (4).…”