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People whose cancer treatment is delayed by a month are in many cases 6 to 13% higher risk of death – a risk that increases the longer their treatment is not started – suggests a study published online in the BMJ.

Canadian and British researchers found that there was a significant impact on a person’s mortality when their treatment was delayed, be it surgical, systemic therapy (like chemotherapy) or radiation therapy for seven cancers.

Health systems around the world have problems with delays in cancer treatment, and it is already widely recognized that such delays can have an adverse effect on a patient’s outcome. However, the precise effects of delays from diagnosis to receiving treatment on mortality have not been thoroughly analyzed.

The need for a better understanding of the impact of treatment delay on outcomes has come into focus during the COVID-19 pandemic as elective cancer surgery and radiation therapy have been postponed and the use of systemic therapies has been reduced in many countries while health systems have been targeted Resources to prepare for the pandemic.

Therefore, a team of researchers, led by Timothy Hanna of Queen’s University in Kingston, Canada, conducted a review and analysis of relevant studies on the topic published between January 2000 and April 2020.

These studies included data on surgery, systemic therapy (such as chemotherapy), or radiation therapy for seven cancers – bladder, breast, colon, rectum, lungs, cervix, and head and neck – which together account for 44% of all cancers worldwide.

Their main outcome was overall survival risk per four week delay for each indication, and delays were measured from diagnosis to first treatment or from completion of one treatment to start of the next.

They found 34 suitable studies for 17 types of diseases that needed treatment (indications), in which a total of more than 1.2 million patients participated. The association between delay and increased mortality was significant for 13 of these 17 indications.

Analysis of the results showed that for all three treatment approaches, a treatment delay of four weeks was associated with an increase in the risk of death.

For surgical interventions, this was a 6-8% increase in risk of death for every four weeks of treatment delay, while the effects were more pronounced with some radiotherapies and systemic indications, with the risk of death definitely increasing by 9% and 13%, respectively, for head and neck radiotherapy and head and neck radiotherapy. adjuvant (follow-up) systemic treatment of colon cancer.

In addition, the researchers calculated that delays of up to eight weeks and 12 weeks further increased the risk of death, using the example of an eight week delay in breast cancer surgery, which would increase the risk of death by 17%, and a delay of 12 weeks that would increase the risk by 26%.

A surgical delay of 12 weeks for all breast cancer patients by one year (e.g. during lockdown and recovery from COVID-19) would result in 1,400 deaths in the UK, 6,100 in the US, 700 in Canada and 500 in Australia Deaths Assume that surgery was the first treatment 83% of the time, and immediate mortality was 12%.

The researchers used an example from the UK NHS, which developed an algorithm to prioritize the operation at the start of the COVID-19 pandemic.

A number of conditions were considered safe to be delayed for 10 to 12 weeks with no predicted impact on outcome, including any colorectal surgery.

“Therefore, our results can help inform policy directly. We found that increasing the waiting time to surgery from six weeks to twelve weeks would increase the risk of death in this situation by 9%,” they said.

The authors acknowledged that their study had limitations, such as the fact that it relied on data from observational research that cannot perfectly pinpoint the cause, and that patients with longer delays in treatment due to multiple illnesses or worse outcomes should have worse outcomes for treatment morbidity.

However, their analysis was based on a large amount of data and they made sure that they only included high quality studies with high validity, which meant that they were measuring exactly what they were studying.

Hanna summarizes: “A four-week delay in treatment is associated with an increase in mortality in all common forms of cancer treatment, with longer delays becoming increasingly detrimental.

“In light of these results, measures to minimize system-level delays in initiating cancer treatment could improve survival outcomes at the population level.”

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More information:
Mortality due to delays in cancer treatment: systematic review and meta-analysis, BMJ (2020). DOI: 10.1136 / bmj.m4087 Provided by the British Medical Journal

Quote: Every month that cancer treatment is delayed can increase the risk of death by about 10% (2020, November 4th). This will be accessed on November 5, 2020 at

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