Research published in the BMJ has concluded that it is essential to minimalise delays to cancer treatments as analysis showed that mortality increased exponentially with every passing week.
Understanding the implications that delays to treatment have on prognosis, and mortality, is particularly pertinent during the current Covid-19 pandemic, while health services reallocate resources and backlogs build up.
It has reported widely that a decline in diagnoses and referrals have contributed to a global increase in excess deaths. Recent ONS stats have represented this phenomenon, which showed a higher than average five-year mortality rate in private homes caused by heart disease, dementia/Alzheimers disease, lung cancer, and high-risk gendered cancers.
A four-week treatment delay increases death risk in all common forms of cancer treatment
An international team of researchers led by Timothy Hanna from Queen’s University, Kingston Canada, carried out a review and meta-analysis of already published data on the treatment for seven forms of cancer that make up 44% of all cancers globally: bladder, breast, colon, rectum, lung, cervix, and head and neck. The research established that delays to surgical procedures, systemic therapies (such as chemotherapy), and radiotherapy significantly increased the mortality rate.
Results showed that across all three treatment approaches, a treatment delay of four weeks was associated with an increased mortality risk for 17 types of conditions. Moreover, a prolonged delay of between eight and twelve weeks would significantly increase death risk.
For example, eight-week delays in breast cancer surgery would increase the risk of death by 17%, and a further twelve-week delay would increase the risk by 26%. Furthermore, when applied to a national context, a surgical delay of twelve-weeks for all patients with breast cancer would lead to 1,400 excess deaths in the UK, 6,100 in the US, 700 in Canada, and 500 in Australia, assuming that surgery was their first treatment in 83% of cases.
Consequently, the researchers argued that minimising delays to treatment is essential to improve cancer survival rates. Researchers pointed to an NHS algorithm used earlier this year to prioritise surgery during the first Covid-19 wave, which considered several conditions to be safe to be delayed for ten to twelve weeks with no predicted impact on prognosis or mortality.
Timothy Hanna said: “A four-week delay in treatment is associated with an increase in mortality across all common forms of cancer treatment, with longer delays being increasingly detrimental… In light of these results, policies focused on minimising system-level delays in cancer treatment initiation could improve population level survival outcomes."