Increasing Wait Times for Cancer Surgery Raise Concerns

Cancer patients are facing longer wait times between diagnosis and the start of first-course therapy, a concerning trend that may have significant implications for their treatment outcomes. A retrospective cohort study of over 2.7 million patients with nonmetastatic stage I-III breast, colon, lung, pancreatic, gastric, or esophageal cancer found that the median time from diagnosis to first-course therapy increased across all malignancies from 2012 to 2023.

Wait Times by Cancer Type

The study found that 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. The proportion of patients experiencing "extreme" delays of 60 or more days to first-course treatment also increased for each cancer type.

Predictors of Longer Wait Times

Predictors of longer wait times included Medicaid insurance, lowest-quartile income, Black race, increased travel distance, and treatment at academic institutions. The study found that these delays disproportionately affect vulnerable populations and are more pronounced at academic and high-volume centers. The authors suggested that 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.

Clinical Significance and Implications

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 increased risk of mortality in lung, breast, gastric, and esophageal cancer, as well as a higher likelihood of tumor progression in pancreatic cancer. The study's findings highlight the need for timely access to cancer care and the importance of considering timeliness as a core dimension of healthcare quality alongside traditional outcome measures.

The study included a total of 2,731,059 patients in the National Cancer Database diagnosed with six cancer types from January 2012 to December 2023 who underwent definitive surgical resection. The authors identified a number of factors associated with longer wait times to first-course treatment, including higher comorbidity burden, more recent diagnosis year, Medicaid insurance, uninsured status, lowest-quartile income, Black race, and greater travel distance. Neoadjuvant therapy was associated with longer wait times for breast and colon cancer, but shorter wait times for lung, gastric, and esophageal cancers. Hospital factors, such as treatment at academic centers and use of robotic surgery, were also associated with longer wait times. The study's findings have significant implications for cancer care and highlight the need for improved care coordination and strategic capacity expansion to ensure timely and equitable access to surgical care.