Timely Treatment for Common Cancers May Be Associated with Mortality

Time-to-treatment initiation (TTI) may have an impact on survival in patients with certain common cancers, according to a study.

Patients with nonmetastatic breast, prostate, non-small cell lung (NSCLC), and colon cancers from 2004 to 2015 were identified. Treatment and outcome data were analyzed from January to March 2020. The National Cancer Database was queried for outcomes correlated with surgical, radiation, or medical therapies. The main outcomes were five- and 10-year predicted all-cause mortality.

A total of 2,241,706 patients were identified. The mean age (standard deviation) was 63 (11.9) years. Most patients were White (n=1,880,317 [83.9%]) and female (n=1,268,794 [56.6%]). The most common cancer was breast cancer (n=1,165,585 [52%]), followed by prostate cancer (n=853,030 [38.1%]), NSCLC (n=130,597 [5.8%]), and colon cancer (n=92,494 [4.1%]).

When stratified by cancer the median TTI was: breast cancer, 32 days (interquartile range [IQR], 21-48 days); prostate cancer, 79 days (IQR, 55-117 days); NSCLC, 41 days (IQR, 27-62 days); and colon cancer, 26 days (IQR, 16-40 days).

A correlation was observed between increased five- and 10-year predicted mortality and increasing TTI in all cancer types; the most significant association between survival and TTI was observed in stage III colon cancer (five-year predicted mortality: TTI 61-120 days, 38.9% vs. 181-365 days, 47.8%), and stage I NSCLC (five-year predicted mortality: TTI 61-120 days, 47.4% vs. 181-365 days, 47.6%), and the least significant association was observed in high-risk prostate cancer (five-year predicted mortality: TTI 61-120 days, 12.8% vs. 181-365 days, 14.1%) and stage I breast cancer (five-year predicted mortality: TTI 61-120 days, 11.0% vs. 181-365 days, 15.2%).

The study was published in JAMA Network Open.

“Examining delayed curative-intent treatment for breast, lung, colon, and prostate cancer, we found that all benefitted to some degree from a short interval between diagnosis and therapy. Some of our findings differ from current guideline recommendations. Specifically, our data support only limited deferral for prostate cancer, with length of deferral dependent on risk stratification,” the researchers concluded.