Delaying Start of Cancer Treatment Reduces Chance of Survival

Prolonging time to treatment initiation (TTI) among patients with newly diagnosed cancer is associated with a significant increase in mortality, a recent Cleveland Clinic study found.

Receiving a cancer diagnosis is already mentally taxing on a patient, and waiting to start therapy only adds to the stress. Furthermore, this delay could negatively affect outcomes.

For the study, investigators used prospective data from the National Cancer Database to examine the number of days between diagnosis and first treatment for patients with newly diagnosed early-stage solid-tumor cancer from 2004 to 2013.

The study population consisted of 3,672,561 patients with breast, prostate, colorectal, non-small cell lung (NSCLC), renal, and pancreatic cancers.

The median TTI increased from 21 days in 2004 to 29 days in 2013. Determinants of delays included care at academic centers and changes in treatment facilities.

Prolonged TTI was associated with worsened overall survival (OS) among patients with stage I and II breast, lung, renal, and pancreas cancers, as well as stage II colorectal cancers. Mortality risk increased from 1.2% to 3.2% per week of delay.

Delaying TTI longer than 6 weeks was associated with substantially worsened OS. For example, the 5-year survival for stage I NSCLC was 56% for TTI of less than or equal to 6 weeks compared with 43% for TTI greater than 6 weeks. Similarly, stage I pancreas cancer was 38% compared with 29%, respectively.

“In addition to its impact on outcomes, delayed TTI can cause unnecessary stress and anxiety for patients,” said senior author Dr Brian Bolwell. “Coordinating care is challenging, particularly in academic cancer centers, but once you take the time to identify all the hurdles, and address each of them, progress in TTI is attainable.”

Two years ago, Cleveland Clinic cancer programs made it their priority to reduce TTI for cancer patients, according to a press release. Initially, TTI was similar to other major cancer centers, but has since decreased 17.5% overall. Its breast, lung, and colorectal cancer programs have seen the greatest reduction.

The Cleveland Clinic hopes to eventually reduce TTI to less than 20 days, according to the release.

“Physicians need to commit to multidisciplinary are and create integrated practice units that focus on patients,” said first author Dr Alok Khorana. “TTI needs to be measures and emphasized, and we must understand what is significant to each individual patient and not assume we already know.”

The authors concluded that “Simplifying access and navigation of complex health systems is essential to diminish this apparently iatrogenic impact on outcomes.”

The findings were presented at the 2017 ASCO annual meeting in Chicago.