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11-11-2020 | Oncology | News | Article

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Meta-analysis highlights raised mortality risk due to cancer treatment delays

Shreeya Nanda

medwireNews: Delaying cancer treatment by even 4 weeks is associated with an increased mortality risk, say researchers who investigated the impact of delays across surgical, systemic therapy, and radiotherapy indications for seven tumor types.

“Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes,” they write in The BMJ.

The team adds a note of caution, however, by acknowledging that “treatment delays are multifactorial in cause and that patients should not start treatment before they are medically fit to do so, and have had completed all appropriate evaluations.”

Timothy Hanna (Queen’s University, Kingston, Ontario, Canada) and co-authors focused on “high validity studies” that reported on treatment delays and survival across all three curative modalities – namely surgery, systemic therapy, and radiotherapy – in the radical, neoadjuvant, or adjuvant setting for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck.

The meta-analysis, which included 34 retrospective observational studies published in January 2000–April 2020, showed that each 4-week delay in surgery was significantly associated with an increased risk for death, at a hazard ratio (HR) of 1.06 for bladder, colon, and head and neck cancer and of 1.08 for breast cancer.

“The results for lung surgery were consistent with other sites, though not statistically significant,” with an HR of 1.06 for every 4-week delay, say the study authors.

Delays in neoadjuvant therapy for bladder or breast cancer were also significantly associated with an increased mortality risk, with HRs for each 4-week delay of 1.24 and 1.28, respectively. This was also the case for adjuvant therapy delays in patients with breast or colorectal cancer, where the HRs were a respective 1.09 and 1.13.

By contrast, there was no significant association between mortality risk and delays in adjuvant chemotherapy for non-small-cell lung cancer or bladder cancer.

The researchers note that “[h]igh validity data on curative radiotherapy were limited,” but where available, “supported a mortality impact of delay.” For instance, every 4-week delay in radical radiotherapy for head and neck cancer was associated with a significant HR for mortality of 1.09, while the HR was a significant 1.23 for each 4-week delay in adjuvant radiotherapy for cervical cancer.

Sensitivity analyses including “studies that could be considered of borderline validity” showed “little change in our estimates, except for breast cancer neoadjuvant systemic treatment,” say Hanna and colleagues.

They note that “[t]he study results are timely in light of the current covid-19 pandemic,” a viewpoint that independent commentator Aleix Prat, Head of Medical Oncology at Hospital Clínic Barcelona in Spain, agrees with.

Prat told medwireNews that "the current pandemic is delaying cancer diagnosis and treatment,” with his department observing a substantial decrease of around 20% in the number of first visits from January to October 2020 relative to the same period in 2019.

“This delay is already impacting the health of our patients,” he commented, and although “the mid- and long-term effects are yet to be quantified, […] this study clearly shows that we must be very worried and actions are needed.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

11 November 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

BMJ 2020; 371: m4087

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