Cargando…
Time to initial cancer treatment in the United States and association with survival over time: An observational study
BACKGROUND: Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. METHODS...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396925/ https://www.ncbi.nlm.nih.gov/pubmed/30822350 http://dx.doi.org/10.1371/journal.pone.0213209 |
_version_ | 1783399343308406784 |
---|---|
author | Khorana, Alok A. Tullio, Katherine Elson, Paul Pennell, Nathan A. Grobmyer, Stephen R. Kalady, Matthew F. Raymond, Daniel Abraham, Jame Klein, Eric A. Walsh, R. Matthew Monteleone, Emily E. Wei, Wei Hobbs, Brian Bolwell, Brian J. |
author_facet | Khorana, Alok A. Tullio, Katherine Elson, Paul Pennell, Nathan A. Grobmyer, Stephen R. Kalady, Matthew F. Raymond, Daniel Abraham, Jame Klein, Eric A. Walsh, R. Matthew Monteleone, Emily E. Wei, Wei Hobbs, Brian Bolwell, Brian J. |
author_sort | Khorana, Alok A. |
collection | PubMed |
description | BACKGROUND: Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. METHODS AND FINDINGS: We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. CONCLUSIONS: TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients. |
format | Online Article Text |
id | pubmed-6396925 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-63969252019-03-08 Time to initial cancer treatment in the United States and association with survival over time: An observational study Khorana, Alok A. Tullio, Katherine Elson, Paul Pennell, Nathan A. Grobmyer, Stephen R. Kalady, Matthew F. Raymond, Daniel Abraham, Jame Klein, Eric A. Walsh, R. Matthew Monteleone, Emily E. Wei, Wei Hobbs, Brian Bolwell, Brian J. PLoS One Research Article BACKGROUND: Delays in time to treatment initiation (TTI) for new cancer diagnoses cause patient distress and may adversely affect outcomes. We investigated trends in TTI for common solid tumors treated with curative intent, determinants of increased TTI and association with overall survival. METHODS AND FINDINGS: We utilized prospective data from the National Cancer Database for newly diagnosed United States patients with early-stage breast, prostate, lung, colorectal, renal and pancreas cancers from 2004–13. TTI was defined as days from diagnosis to first treatment (surgery, systemic or radiation therapy). Negative binomial regression and Cox proportional hazard models were used for analysis. The study population of 3,672,561 patients included breast (N = 1,368,024), prostate (N = 944,246), colorectal (N = 662,094), non-small cell lung (N = 363,863), renal (N = 262,915) and pancreas (N = 71,419) cancers. Median TTI increased from 21 to 29 days (P<0.001). Aside from year of diagnosis, determinants of increased TTI included care at academic center, race, education, prior history of cancer, transfer of facility, comorbidities and age. Increased TTI was associated with worsened survival for stages I and II breast, lung, renal and pancreas cancers, and stage I colorectal cancers, with hazard ratios ranging from 1.005 (95% confidence intervals [CI] 1.002–1.008) to 1.030 (95% CI 1.025–1.035) per week of increased TTI. CONCLUSIONS: TTI has lengthened significantly and is associated with absolute increased risk of mortality ranging from 1.2–3.2% per week in curative settings such as early-stage breast, lung, renal and pancreas cancers. Studies of interventions to ease navigation and reduce barriers are warranted to diminish potential harm to patients. Public Library of Science 2019-03-01 /pmc/articles/PMC6396925/ /pubmed/30822350 http://dx.doi.org/10.1371/journal.pone.0213209 Text en © 2019 Khorana et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Khorana, Alok A. Tullio, Katherine Elson, Paul Pennell, Nathan A. Grobmyer, Stephen R. Kalady, Matthew F. Raymond, Daniel Abraham, Jame Klein, Eric A. Walsh, R. Matthew Monteleone, Emily E. Wei, Wei Hobbs, Brian Bolwell, Brian J. Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title | Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title_full | Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title_fullStr | Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title_full_unstemmed | Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title_short | Time to initial cancer treatment in the United States and association with survival over time: An observational study |
title_sort | time to initial cancer treatment in the united states and association with survival over time: an observational study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396925/ https://www.ncbi.nlm.nih.gov/pubmed/30822350 http://dx.doi.org/10.1371/journal.pone.0213209 |
work_keys_str_mv | AT khoranaaloka timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT tulliokatherine timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT elsonpaul timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT pennellnathana timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT grobmyerstephenr timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT kaladymatthewf timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT raymonddaniel timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT abrahamjame timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT kleinerica timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT walshrmatthew timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT monteleoneemilye timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT weiwei timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT hobbsbrian timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy AT bolwellbrianj timetoinitialcancertreatmentintheunitedstatesandassociationwithsurvivalovertimeanobservationalstudy |