El tiempo de espera para la cirugía del cáncer está aumentando, según un estudio

Cancer patients are facing longer wait times between diagnosis and the start of first-course therapy, a retrospective cohort study suggested.

Among more than 2.7 million patients with nonmetastatic stage I-III breast, colon, lung, pancreatic, gastric, or esophageal cancer, the median time from diagnosis to first-course therapy increased across all malignancies from 2012 to 2023, reported Timothy R. Donahue, MD, of the University of California Los Angeles, and colleagues.

Over that period, wait times increased from 34 to 45 days for breast cancer, 20 to 31 days for colon cancer, 41 to 53 days for lung cancer, 23 to 32 days for pancreatic cancer, 35 to 49 days for gastric cancer, and 38 to 48 days for esophageal cancer (P for trend <0.001 for all cancers) among those undergoing upfront surgery or neoadjuvant therapy, they noted in JAMA Surgeryopens in a new tab or window.

Of note, the proportion of patients experiencing «extreme» delays (60 or more days) to first-course treatment also increased for each cancer type.

Predictors of longer wait times included Medicaid insurance, lowest-quartile income, Black race, increased travel distance, and treatment at academic institutions, among other factors.

«These delays disproportionately affect vulnerable populations and are more pronounced at academic and high-volume centers,» Donahue and colleagues wrote. «As cancer care continues to centralize within expanding, consolidated health systems, improved care coordination, streamlined referral pathways, standardized timeliness benchmarks, and strategic capacity expansion will be required to ensure timely and equitable access to surgical care.»

The authors acknowledged that their study did not evaluate the association between treatment delay and oncologic outcomes, but suggested that the clinical significance of the results should be «contextualized within existing literature linking delayed surgical care with inferior survival across cancer types.»

They pointed to studies showing that delayed surgical care is associated with an approximately 20% to 30% increased risk of both 90-day and 5-year mortality in lung cancer, an approximately 10% to 15% greater likelihood of mortality in breast cancer, an approximately 15% increased relative risk of overall mortality in gastric cancer, a nearly twofold greater mortality in locally advanced esophageal cancer, and a higher likelihood of tumor progression in pancreatic cancer.

In an accompanying commentaryopens in a new tab or window, Lia D. Delaney, MD, and Sherry M. Wren, MD, both of the Stanford School of Medicine in Palo Alto, California, noted that «cancer care has become increasingly sophisticated, centralized, and multidisciplinary» over the last two decades, and «these changes have improved outcomes for many patients.»

However, «as cancer care continues to regionalize, efforts to improve quality may inadvertently create barriers to timely treatment unless capacity and coordination evolve in parallel,» they wrote.

«Timeliness should be considered a core dimension of healthcare quality alongside traditional outcome measures,» Delaney and Wren argued. «The modern oncology system has optimized for specialization but not necessarily for timeliness. As cancer care continues to regionalize, timely access may become as important to healthcare quality as specialized expertise itself.»

This study included a total of 2,731,059 patients in the National Cancer Database (NCDB) diagnosed with six cancer types from January 2012 to December 2023 who underwent definitive surgical resection. Mean age was 63.5 years, and 85% were female.

After comprehensive risk adjustment, Donahue and colleagues identified a number of factors associated with longer wait times to first-course treatment, including higher comorbidity burden and more recent diagnosis year (all 6 cancer types), Medicaid insurance (5 of 6 cancers), uninsured status (3 of 6 cancers), lowest-quartile income (all 6 cancers), Black race (5 of 6 cancers), and greater travel distance (4 of 6 cancers).

Neoadjuvant therapy was associated with longer wait times for breast and colon cancer, but shorter wait times for lung, gastric, and esophageal cancers.

With respect to hospital factors, treatment at academic centers was associated with longer wait times compared with community hospitals (all 6 cancers), as was treatment in the West and Northeast (all 6 cancers), while use of robotic surgery was associated with increased wait times for non-breast malignancies.

Donahue and colleagues noted that the NCDB does not capture the timing of symptom onset or the rationale underlying treatment delays. They were also unable to determine the relative contributions of patient preferences, scheduling constraints, or second opinions, or the clinical rationale underlying individual treatment decisions.

Disclaimer: This information is intended for educational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Fuente: https://www.medpagetoday.com/hematologyoncology/othercancers/122578