Delays in the application of cancer treatment can have negative consequences for patients’ survival

Delaying the proper treatment of cancer (surgical, systemic or radiotherapy) can have negative consequences on the evolution of cancer patients. This delay is common throughout the world and is a public health problem that affects all health systems. A study published in the British Medical Journal in 2020 confirms the existing suspicion of the consequences of delayed treatment in cancer. This study analyzed neoadjuvant and adjuvant indications for surgery, systemic treatment or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck. “The main outcome measure was represented by 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. The review included 34 studies for 17 indications (n=1,272,681 patients). The results of this study show that the association between delay and increased mortality was significant (p<0.05) for 13 of 17 indications. All medical procedures were negatively influenced by delay of treatment. Estimates for systemic treatment used in medical oncology varied (hazard ratio range: 1.01-1.28)”. In conclusion, the authors stated that cancer treatment delay is a problem in health systems worldwide. The results show that even a four-week delay of cancer treatment is associated with an increased mortality across surgical, systemic treatment and radiotherapy indications for all cancers introduced in the study. “Policies focused on minimizing system level delays to cancer treatment initiation could improve population level survival outcomes”⁽¹⁾.

Another study (“The effect of a 7-day delay in chemotherapy cycles on complete response and event-free survival in good-risk disseminated germ cell tumor patients”) showed the implication of delay, in particular of seven days, for the results of the treatment in that particular cancer. The conclusion of this study was that “short, planned delays in chemotherapy for good-risk GCT patients (less than or equal to seven days per cycle) appear to be acceptable since they may prevent serious toxicity in this curable patient population. Delays longer than seven days are strongly discouraged except in extraordinary life-threatening circumstances”⁽²⁾.

In Romania, there is also a delay in starting the systemic treatment, the causes of this delay being various: late diagnosis, cumbersome planning of investigations, lack of collaboration between health units where the patient is treated. Another important shortcoming in the practice of medical oncology in Romania is the one related to the purchase of medicines, so the medical oncologist must submit to the insurance company the request for additional budget for medicines, a request based on the patient’s diagnosis and personal data. This request must be countersigned by the hospital pharmacist and the manager. Then, the insurance company sends the money and the hospital buys the medicine. The distributors are then expected to send the medicine to the hospital. During all this time, the patient waits for treatment and sometimes the disease worsens and the treatment scheme initially proposed no longer matches his performance status. We consider that the simplification of this working methodology is absolutely necessary.