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Time matters! The importance of immediate treatment initiation

In monday´s Health Services Research, Clinical Informatics, and Quality of Care Session, Prof. Alok Khorana presented an abstract evaluating trends in time to initiating treatment (TTI) in common solid tumors in the US.

An increased treatment delay causes newly diagnosed cancer patients distress and may adversely affect outcomes. The current analysis utilized population-based, prospective data from the National Cancer Database for newly diagnosed US patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004-13 (n = 3 672 561) to investigate trends in TTI for common solid tumors treated with curative intent, determinants of delayed TTI and impact on overall survival. TTI was defined as days between diagnosis of cancer and first treatment (surgery, systemic or radiation therapy).

Between 2004 and 2013, treatment delay increased from 21 to 29 days. Prolonged TTI was associated with worsened overall survival (OS) for stages I and II breast, lung, renal, and pancreas cancers, and stage II colorectal cancers, with hazard ratios per week of delay ranging from 1.005 to 1.030; TTI > 6 weeks resulted in substantially worsened 5-year OS, e.g. in stage I NSCLC (56% ≤ 6wks vs. 43% > 6 wks) or stage I pancreas cancer (38% vs 29%).

The analysis showed that the increase in TTI is associated with substantial increase in mortality ranging from 0.5-3.2% per week of delay in curative settings such as early-stage breast, lung and pancreas cancers. Simplifying access and navigation of complex health systems is essential to diminish this apparently iatrogenic impact on outcomes.


Khorana AA et al., abstract 6557: Increase in time to initiating cancer therapy and association with worsened survival in curative settings: A U.S. analysis of common solid tumors.



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