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
- 987 Downloads
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.
KeywordsBreast Cancer Thyroid Cancer Treatment Delay Adjusted Hazard Ratio Large Cell Carcinoma
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.
- 26.Hwang EJ, Kang J, Kim HY, Cho JY, Shin DW. Regional variation in the supply of palliative care beds in Korea. Health Serv Manage Rev. 2009;3:31–9.Google Scholar
- 38.Calman K, Hine D. A policy framework for commissioning cancer services: a report by the expert advisory group on cancer to the chief medical officers of England and Wales. London: Department of Health, 1995.Google Scholar
- 42.ClinicalTrials.gov. Treatment decision-making among patients diagnosed with papillary microcarcinoma and their significant others. 2011. http://clinicaltrials.gov/ct2/show/NCT01392222.