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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

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Fradet Y, Aprikian A, Dranitsaris G, Siemens R, Tsihlias J, Fleshner N. Does prolonging the time to bladder cancer surgery affect long-term cancer control? A systematic review of the literature. Can J Urol. 2006;13(Suppl 3):37–47.

    PubMed  Google Scholar 

  2. Bardell T, Belliveau P, Kong W, Mackillop WJ. Waiting times for cancer surgery in Ontario: 1984–2000. Clin Oncol. 2006;18:401–9.

    Article  CAS  Google Scholar 

  3. Jewett M, Rendon R, Dranitsaris G, et al. Does prolonging the time to renal cancer surgery affect long-term cancer control: a systematic review of the literature. Can J Urol. 2006;13(Suppl 3):54–61.

    PubMed  Google Scholar 

  4. Kawakami J, Hopman WM, Smith-Tryon R, Siemens DR. Measurement of surgical wait times in a universal health care system. Can Urol Assoc J. 2008;2:597–603.

    PubMed  Google Scholar 

  5. Kulkarni GS, Urbach DR, Austin PC, Fleshner NE, Laupacis A. Longer wait times increase overall mortality in patients with bladder cancer. J Urol. 2009;182:1318–24.

    Article  PubMed  Google Scholar 

  6. Mayo NE, Scott SC, Shen N, Hanley J, Goldberg MS, MacDonald N. Waiting time for breast cancer surgery in Quebec. CMAJ. 2001;164:1133–8.

    PubMed  CAS  Google Scholar 

  7. Willcox S, Seddon M, Dunn S, Edwards RT, Pearse J, Tu JV. Measuring and reducing waiting times: a cross-national comparison of strategies. Health Aff (Millwood). 2007;26:1078–87.

    Article  PubMed  Google Scholar 

  8. Lee CT, Madii R, Daignault S, et al. Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival. J Urol. 2006;175:1262–7.

    Article  PubMed  Google Scholar 

  9. Wagner JL, Warneke CL, Mittendorf EA, et al. Delays in primary surgical treatment are not associated with significant tumor size progression in breast cancer patients. Ann Surg. 2011;254:119–24.

    Article  PubMed  Google Scholar 

  10. Saad F, Finelli A, Dranitsaris G, et al. Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature. Can J Urol. 2006;13(Suppl 3):16–24.

    PubMed  Google Scholar 

  11. Bell D, Morash C, Dranitsaris G, et al. Does prolonging the time to testicular cancer surgery impact long-term cancer control: a systematic review of the literature. Can J Urol. 2006;13(Suppl 3):30–6.

    PubMed  Google Scholar 

  12. Chang SS, Hassan JM, Cookson MS, Wells N, Smith JA Jr. Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol. 2003;170:1085–7.

    Article  PubMed  Google Scholar 

  13. Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS. Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a surveillance, epidemiology, and end results-medicare analysis. Cancer. 2009;115:988–96.

    Article  PubMed  Google Scholar 

  14. Mahmud SM, Fong B, Fahmy N, Tanguay S, Aprikian AG. Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population based study. J Urol. 2006;175:78–83.

    Article  PubMed  Google Scholar 

  15. May M, Nitzke T, Helke C, Vogler H, Hoschke B. Significance of the time period between diagnosis of muscle invasion and radical cystectomy with regard to the prognosis of transitional cell carcinoma of the urothelium in the bladder. Scand J Urol Nephrol. 2004;38:231–5.

    Article  PubMed  CAS  Google Scholar 

  16. Sanchez-Ortiz RF, Huang WC, Mick R, Van Arsdalen KN, Wein AJ, Malkowicz SB. An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol. 2003;169:110–5.

    Article  PubMed  Google Scholar 

  17. Liedberg F, Anderson H, Mansson W. Treatment delay and prognosis in invasive bladder cancer. J Urol. 2005;174:1777–81.

    Article  PubMed  Google Scholar 

  18. Nielsen ME, Palapattu GS, Karakiewicz PI, et al. A delay in radical cystectomy of >3 months is not associated with a worse clinical outcome. BJU Int. 2007;100:1015–20.

    PubMed  Google Scholar 

  19. Vujovic O, Yu E, Cherian A, et al. Effect of interval to definitive breast surgery on clinical presentation and survival in early-stage invasive breast cancer. Int J Radiat Oncol Biol Phys. 2009;75:771–4.

    Article  PubMed  Google Scholar 

  20. Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79:858–64.

    Article  PubMed  CAS  Google Scholar 

  21. Holmstrom B, Holmberg E, Egevad L, et al. Outcome of primary versus deferred radical prostatectomy in the National Prostate Cancer Register of Sweden Follow-Up Study. J Urol. 2010;184:1322–7.

    Article  PubMed  Google Scholar 

  22. van den Bergh RC, Steyerberg EW, Khatami A, Aus G, Pihl CG, Wolters T, et al. Is delayed radical prostatectomy in men with low-risk screen-detected prostate cancer associated with a higher risk of unfavorable outcomes? Cancer. 2010;116:1281–90.

    Article  PubMed  Google Scholar 

  23. Warlick C, Trock BJ, Landis P, Epstein JI, Carter HB. Delayed versus immediate surgical intervention and prostate cancer outcome. J Natl Cancer Inst. 2006;98:355–7.

    Article  PubMed  Google Scholar 

  24. Nguyen PL, Whittington R, Koo S, et al. The impact of a delay in initiating radiation therapy on prostate-specific antigen outcome for patients with clinically localized prostate carcinoma. Cancer. 2005;103:2053–9.

    Article  PubMed  Google Scholar 

  25. Won YJ, Sung J, Jung KW, et al. Nationwide cancer incidence in Korea, 2003–2005. Cancer Res Treat. 2009;41:122–31.

    Article  PubMed  Google Scholar 

  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 

  27. Lee JA, Park JH, Lee EJ, Kim SY, Kim Y, Lee SI. High-quality, low-cost gastrectomy care at high-volume hospitals: results from a population-based study in South Korea. Arch Surg. 2011;146:930–6.

    Article  PubMed  Google Scholar 

  28. Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI. Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat. 2006;99:313–21

    Article  PubMed  CAS  Google Scholar 

  29. Comber H, Cronin DP, Deady S, Lorcain PO, Riordan P. Delays in treatment in the cancer services: impact on cancer stage and survival. Ir Med J. 2005;98:238–9.

    PubMed  CAS  Google Scholar 

  30. Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209:180–7.

    Article  PubMed  Google Scholar 

  31. Reed AD, Williams RJ, Wall PA, Hasselback P. Waiting time for breast cancer treatment in Alberta. Can J Public Health. 2004;95:341–5.

    PubMed  Google Scholar 

  32. Williams TE Jr, Satiani B, Thomas A, Ellison EC. The impending shortage and the estimated cost of training the future surgical workforce. Ann Surg. 2009;250:590–7.

    Article  PubMed  Google Scholar 

  33. Fleshner N, Dranitsaris G, Finelli A, Tsihlias J, Bell D, Gleave M. Surgical wait times for patients with urological cancers: a survey of Canadian surgeons. Can J Urol. 2006;13(Suppl 3):3–13.

    PubMed  Google Scholar 

  34. Bilimoria KY, Ko CY, Tomlinson JS, et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg. 2011;253:779–85.

    Article  PubMed  Google Scholar 

  35. Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. CMAJ. 2001;165:421–5.

    PubMed  CAS  Google Scholar 

  36. Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000;18:2327–40.

    PubMed  CAS  Google Scholar 

  37. Payne S, Jarrett N, Jeffs D. The impact of travel on cancer patients’ experiences of treatment: a literature review. Eur J Cancer Care. 2000;9:197–203.

    Article  CAS  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 

  39. Iversen LH, Antonsen S, Laurberg S, Lautrup MD. Therapeutic delay reduces survival of rectal cancer but not of colonic cancer. Br J Surg. 2009;96:1183–9.

    Article  PubMed  CAS  Google Scholar 

  40. Canizares Carretero MA, Rivo Vazquez JE, Blanco Ramos M, Toscano Novella A, Garcia Fontan EM, Purrinos Hermida MJ. Influence of delay of surgery on the survival of patients with bronchogenic carcinoma. Arch Bronconeumol. 2007;43:165–70.

    Article  PubMed  Google Scholar 

  41. Davies L, Welch HG. Thyroid cancer survival in the United States: observational data from 1973 to 2005. Arch Otolaryngol Head Neck Surg. 2010;136:440–4.

    Article  PubMed  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.

  43. Kern KA. Medicolegal analysis of the delayed diagnosis of cancer in 338 cases in the United States. Arch Surg. 1994;129:397–403.

    Article  PubMed  CAS  Google Scholar 

  44. Hafstrom L, Johansson H, Ahlberg J. Does diagnostic delay of colorectal cancer result in malpractice claims? A retrospective analysis of the Swedish board of malpractice from 1995–2008. Patient Saf Surg. 2012;6:13

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

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.

Author information

Authors and Affiliations

  1. Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea

    Dong Wook Shin MD, MBA, DrPH & BeLong Cho MD, MPH, PhD

  2. Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Republic of Korea

    Dong Wook Shin MD, MBA, DrPH & BeLong Cho MD, MPH, PhD

  3. Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea

    Juhee Cho PhD, MA

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Juhee Cho PhD, MA & Eliseo Guallar MD, DrPH

  5. Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Juhee Cho PhD, MA

  6. National Cancer Control Research Institute, National Cancer Center, Goyang, Republic of Korea

    So Young Kim MD, PhD, Hong Gwan Seo MD, MPH, PhD & Jong Hyock Park MD, MPH, PhD

  7. Department of Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Eliseo Guallar MD, DrPH

  8. Department of Social and Preventive Medicine, Inha University, Incheon, Republic of Korea

    Seung Sik Hwang MD, PhD

  9. Center for Colorectal Cancer, National Cancer Center, Goyang, Republic of Korea

    Jae Hwan Oh MD, PhD

  10. Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea

    Ki Wook Jung MD, PhD

  11. Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Republic of Korea

    Hong Gwan Seo MD, MPH, PhD

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  1. Dong Wook Shin MD, MBA, DrPH
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  2. Juhee Cho PhD, MA
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  6. BeLong Cho MD, MPH, PhD
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  7. Jae Hwan Oh MD, PhD
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  8. Ki Wook Jung MD, PhD
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Correspondence to Jong Hyock Park MD, MPH, PhD.

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Shin, D.W., Cho, J., Kim, S.Y. et al. 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. Ann Surg Oncol 20, 2468–2476 (2013). https://doi.org/10.1245/s10434-013-2957-y

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  • DOI: https://doi.org/10.1245/s10434-013-2957-y

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