In patients with common cancers, a longer time to treatment initiation is associated with higher all-cause mortality, according to results of a cohort study now published in JAMA Network Open.
"The COVID-19 pandemic has forced many hospitals in the US to grapple with decisions on how best to optimize allocation of limited health care resources," write the investigators, led by Eugene B. Cone, MD, of the Division of Urological Surgery at Brigham and Women's Hospital. "Postponing particular cancer treatments may lead to disease progression, metastasis, and, ultimately, cancer-related death. Guidelines developed by hospitals, states, and professional societies are largely based on expert opinion and often conflict with each other."
Dr. Cone and colleagues investigated the association of time to treatment initiation with overall survival in a cohort study of 2,241,706 patients with common cancers, including breast cancer (52%), prostate cancer (38.1%), non-small cell lung cancer (NSCLC) (5.8%), and colon cancer (4.1%). All patients had nonmetastatic disease and were eligible for therapy according to the National Comprehensive Cancer Network (NCCN) guidelines. The study's primary end points were rates of five-year and 10-year predicted all-cause mortality, with the time between diagnosis and therapy measured in intervals of 8–60 days, 61–120 days, 121–180 days, and greater than 180 days.
The median time to treatment initiation was 32 days for patients with breast cancer, 79 days for those with prostate cancer, 41 days for those with NSCLC, and 26 days for those with colon cancer. Among the total population, a longer time to treatment initiation correlated with a general increase in predicted five-year and 10-year rates of all-cause mortality. Patients with low-risk prostate cancer treated within 60 days of diagnosis experienced the lowest predicted all-cause mortality, with five-year and 10-year rates of 4.9% and 17.3%, respectively. For treatment initiated within 181–365 days compared with 61–120 days, the most significant increase in five-year predicted mortality was seen in patients with stage III colon cancer (47.8% vs 38.9%), followed by stage I breast cancer (15.2% vs 11%), high-risk prostate cancer (14.1% vs 12.8%), and stage I NSCLC (47.6% vs 47.4%).
"Examining delayed curative-intent treatment for breast, lung, colon, and prostate cancer, we found that all benefited to some degree from a short interval between diagnosis and therapy," conclude Dr. Cone and colleagues. "Specifically, our data support only limited deferral for prostate cancer, with length of deferral dependent on risk stratification. Future analyses will expand to other cancers, which may assist with treatment deferral decisions in resource-limited settings and provide a framework for prioritizing treatment as limitations ease."
For More Information
Cone EB, Marchese M, Paciotti M, et al (2020). Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw Open, 3(12):e20130072. DOI:10.1001/jamanetworkopen.2020.30072
Image credit: Bill Branson, courtesy of the National Institutes of Health