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Cited by 1,742COVID-19 and healthcare impactsGlobal Cancer Incidence and ScreeningLung Cancer Diagnosis and Treatment

Mortality due to cancer treatment delay: systematic review and meta-analysis

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Hanna, Timothy P, King, Will D, Thibodeau, Stephane, Jalink, Matthew, Paulin, Gregory A, Harvey-Jones, Elizabeth, O’Sullivan, Dylan E, Booth, Christopher M +2 more·2020·BMJ
DOI 10.1136/bmj.m4087PMC PMC7610021
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Abstract

Objective: To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design: Systematic review and meta-analysis. Data sources: Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies: Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. Results: The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. Conclusions: Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.

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  • A small delay in cancer treatment is associated with increased mortality.

    “Studies have concluded that a small delay in cancer treatment is associated with increased mortality (Hanna et al., 2020)”

    From Medical apartheid in Palestine. (2023) · cites this paper as Hanna et al., 2020

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Sorted by citations

Authors
Hanna, T. P., King, W. D., Thibodeau, S., Jalink, M., Paulin, G. A., Harvey-Jones, E., O’Sullivan, D. E., Booth, C. M., Sullivan, R., & Aggarwal, A.
Affiliations
  • Queen's University (CA)
  • Guy's Hospital (GB)
  • King's College London (GB)
Corresponding author
Hanna, Timothy P
ORCID
Venue
BMJ
Publisher
BMJ
Published
2020-11-04
Volume
371
Pages
m4087
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.m4087
PMC
PMC7610021
OpenAlex
W3095689420
Cited by
1,742
References
4
Citations by year
2026: 218 · 2025: 297 · 2024: 317 · 2023: 255 · 2022: 366 · 2021: 279 · 2020: 6 · 2012: 1
FWCI
24.32
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health and Care Research (NIHR300599)
  • Economic and Social Research Council (ES/P010962/1)
Topics
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
cancer treatment delays, treatment delay, mortality, overall survival, cancer care pathway, neoadjuvant therapy, adjuvant therapy, radiotherapy, systemic therapy, bladder cancer, breast cancer, colon cancer, lung cancer, cervical cancer, head and neck cancer, prognostic factors, comorbidities, functional status, health system performance, quality of care
MeSH terms
Humans, Neoplasms, Risk Factors, Survival Analysis, Time-to-Treatment

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