Annals of Surgical Oncology

, Volume 20, Issue 8, pp 2468–2476 | Cite as

Delay to Curative Surgery Greater than 12 Weeks Is Associated with Increased Mortality in Patients with Colorectal and Breast Cancer but Not Lung or Thyroid Cancer

  • Dong Wook Shin
  • Juhee Cho
  • So Young Kim
  • Eliseo Guallar
  • Seung Sik Hwang
  • BeLong Cho
  • Jae Hwan Oh
  • Ki Wook Jung
  • Hong Gwan Seo
  • Jong Hyock ParkEmail author
Healthcare Policy and Outcomes



Surgery for cancer is often delayed due to variety of patient-, provider-, and health system–related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival.


Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years.


For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1–4 after diagnosis were 2.65 (1.50–4.70) and 1.91 (1.06–3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient’s residence and the hospital performing surgery, and the patient’s income status were associated with delayed surgery.


Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care.


Breast Cancer Thyroid Cancer Treatment Delay Adjusted Hazard Ratio Large Cell Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a Grant from the Ministry of Health and Welfare (Grant 1210150) and received administrative support from the Ministry of Health and Welfare and National Health Insurance Corporation, Korea.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

10434_2013_2957_MOESM1_ESM.doc (33 kb)
Supplementary material 1 (DOC 33 kb)
10434_2013_2957_MOESM2_ESM.tif (751 kb)
Supplementary material 2. Restricted cubic splines of the probability of death by time tosurgery (TIFF 750 kb)


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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Dong Wook Shin
    • 1
    • 2
  • Juhee Cho
    • 3
    • 4
    • 5
  • So Young Kim
    • 6
  • Eliseo Guallar
    • 4
    • 7
  • Seung Sik Hwang
    • 8
  • BeLong Cho
    • 1
    • 2
  • Jae Hwan Oh
    • 9
  • Ki Wook Jung
    • 10
  • Hong Gwan Seo
    • 6
    • 11
  • Jong Hyock Park
    • 6
    Email author
  1. 1.Department of Family Medicine and Health Promotion CenterSeoul National University HospitalSeoulRepublic of Korea
  2. 2.Cancer Survivorship ClinicSeoul National University Cancer HospitalSeoulRepublic of Korea
  3. 3.Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and TechnologySungkyunkwan UniversitySeoulRepublic of Korea
  4. 4.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.National Cancer Control Research InstituteNational Cancer CenterGoyangRepublic of Korea
  7. 7.Department of MedicineWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical InstitutionsBaltimoreUSA
  8. 8.Department of Social and Preventive MedicineInha UniversityIncheonRepublic of Korea
  9. 9.Center for Colorectal CancerNational Cancer CenterGoyangRepublic of Korea
  10. 10.Center for Thyroid CancerNational Cancer CenterGoyangRepublic of Korea
  11. 11.Center for Cancer Prevention and DetectionNational Cancer CenterGoyangRepublic of Korea

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