Cancer treatment delays can have serious consequences: can lead to disease progression, reduced survival rates, and poorer overall outcomes for patients.
Common causes of diagnostic delays:
Healthcare system backlogs Shortages of medical staff or equipment Insurance approval processes Patient-related factors-delayed seeking of care Diagnostic study delays
Types of delays include:
Delays in initial diagnosis Delays between diagnosis and treatment initiation Delays or interruptions during treatment.
Treatment delay is defined as time from diagnosis to treatment for the first treatment, definitive surgery or radiation, and from time of surgery to treatment for adjuvant indications, chemotherapy or radiation after surgery.
For neoadjuvant treatments delay was defined as the time from diagnosis to the start of neoadjuvant treatment, or from the end of neoadjuvant treatment to time of surgery.
Some cancers, like pancreatic or lung cancer, may be more sensitive to treatment delays than others.
Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers.
Previous meta-analyses have found evidence supporting a continuous association between delay and mortality or local control.
Seven cancers that together represent 44% of all incident cancers globally: five common cancers (bladder, breast, colon, rectum, lung); cervical cancer, head and neck cancer, for which there is an established association between delay and mortality.
For surgery, this is a 6-8% increase in the risk of death for every four week delay.
This impact is even more marked for some radiotherapy and systemic indications, with a 9% and 13% increased risk of death for definitive head and neck radiotherapy and adjuvant systemic treatment for colorectal cancer, respectively.
The mortality impact per one month delay for radiotherapy indications for head and neck, breast cancers and similarly for systemic treatment for adjuvant colon, breast cancer treatments show strong empirical basis for estimating the mortality impact of system level delays for different treatment modalities and cancers.
Delays of up to eight weeks and 12 weeks further increase the risk of death.
An eight week delay in breast cancer surgery would increase the risk of death by 17%, and a 12 week delay would increase the risk by 26%.
A surgical delay of 12 weeks for all patients with breast cancer for a year would lead to 6100 excess deaths in the United States.
Delay in diagnosis does not consider the impact of treatment delay on local control rates, functional outcomes, complications from more extensive treatments because of progression during delays, quality of life, or the greater economic burden because of higher direct care costs and productivity losses because of premature mortality and morbidity.
Treatment delays could be due to patient factors: need for cardiac workup, postoperative wound infection, disease factors for the need for additional imaging investigations, or system factors such as waiting for an operating room date, a central line insertion, or a specialist consultation.
COVID-19 impact: The pandemic has exacerbated treatment delays in many regions due to overwhelmed healthcare systems and patients avoiding medical facilities.