Table 2. Characteristics of the systematic reviews on the association between time to cancer diagnosis and/or treatment and clinical outcomes, by cancer site/type and lag time interval.
| Cancer | Lag time | Outcome measures | Overall findings | First author (year) | ||
|---|---|---|---|---|---|---|
| Site | Type | Interval | Time range | |||
| Brain | -- | T33 | 15 to >45 days | Overall survival | 4/10 studies: no association between longer time (>45 days) to treatment initiation and overall survival | Warren et al., 2019 |
| 4/10 studies: best overall survival was among patients who experienced a moderate time (~31–42 days) to treatment initiation | ||||||
| 1/10 studies: a longer time (>45 days) to treatment initiation was associated with poorer overall survival | ||||||
| 1/10 studies: improved survival with early treatment initiation (14–21 days) among patients who underwent total resection, and poorer survival for patients who underwent biopsy only | ||||||
| Colorectal | Rectal | T29 | <5 days to >12 weeks | Tumour response rate R0 resection Sphincter preservation Surgical complications Disease recurrence |
4/15 studies: higher rates of pathological complete response with longer time intervals (6–8 weeks) between chemoradiotherapy and surgery | Foster et al., 2013 |
| 3/15 studies: increased tumour downstaging with longer time intervals (6–8 weeks) | ||||||
| No association between longer time intervals and surgical complication rates, sphincter preservation rates, long-term recurrence rates and survival | ||||||
| Colon | T18 | 1 to ≥56 days | Overall survival Disease-specific survival Cause-specific survival |
4/5 studies: no association between treatment delay and reduced overall survival regardless of the time intervals investigated | Hangaard Hansen et al., 2018 | |
| 1/5 studies: a clinically insignificant association between longer treatment delay and reduced overall survival | ||||||
| No association between treatment delay and reduced disease-specific survival | ||||||
| Eye | Retinoblastoma | T4 | 3 to 5 months | Metastasis Mortality Enucleation Extraocular disease |
2/9 studies: association between time to diagnosis (>6 months) and metastatic disease | Mattosinho et al., 2019 |
| 2/9 studies: extended time to diagnosis associated with increasing extraocular disease and mortality rates | ||||||
| No association between time to diagnosis and enucleation | ||||||
| Head and neck | Oropharyngeal | T17 | 20 to 120 days | Overall survival Disease-specific survival Recurrence-free survival Locoregional control |
9/13 studies: association between longer diagnosis to treatment initiation and poorer overall survival | Graboyes et al., 2019 |
| T30 | >6 to ≥64 days | 4/5 studies: association between shorter time from surgery to postoperative radiotherapy and improved overall survival or recurrence-free survival | ||||
| T31 | 77 to 100 days | 4/5 studies: longer time from surgery to postoperative radiotherapy correlated with poorer overall survival | ||||
| Paediatric | Leukemias, lymphomas, brain tumours, neuroblastomas, kidney tumours, soft tissue sarcomas, germ-cell tumours, retinoblastomas | T4 | 2 to 260 weeks | Overall survival Prognostic factors |
Delayed diagnosis associated with poorer outcomes among patients with retinoblastoma | Brasme et al., 2012 |
| Limited evidence that a delay in diagnosis might be adversely associated with poor oncologic outcomes for patients with leukemia, nephroblastoma, or rhabdomyosarcoma | ||||||
| No association between longer time to diagnosis and oncologic outcomes among patients with osteosarcoma, Ewing’s sarcoma, or a central nervous system tumour | ||||||
| Medulloblastomas, CNS tumours, retinoblastomas, Ewing’s sarcomas, bone tumours, osteosarcomas, adenocarcinomas |
20 to 116 days | Overall survival | Delay in diagnosis associated with poorer survival among patients diagnosed with Ewing’s Family of soft tissue sarcomas | Lethaby et al., 2013 | ||
| Non-linear association between time to diagnosis and survival among patients with central nervous system tumours and non-rhabdomyosarcomas; shortest time to diagnosis associated with poorer survival, however, subsequent extension of time to diagnosis associated with improved survival | ||||||
| Time to diagnosis not associated with survival in patients diagnosed with bone tumours | ||||||
| Prostate | -- | T18, T20 | 56 days to 3.7 months | Pathologic characteristics Biochemical recurrence Distant metastasis Overall survival Cause-specific survival |
7/17 studies: no association between time to treatment and poorer oncologic outcomes | van den Bergh et al., 2013 |
| 4/17 studies: treatment delay resulted in worse biochemical recurrence rates but no association with overall survival, distant metastasis, or cause-specific survival | ||||||
| Prolonged time to treatment (several months or years) does not adversely impact oncologic outcomes in patients with low-risk prostate cancers | ||||||
| Limited evidence suggests that prolonged time to treatment might have a negative effect on patients with moderate- and high-risk prostate cancers | ||||||
| Multisite | Breast, lung, gastric, oesophageal, gastro-esophageal, pancreatic, hepatocellular, colorectal, prostate, testicular, renal, bladder, upper tract urothelial, cervical, endometrial, ovarian, head and neck, brain/CNS, leukemia, lymphoma, myeloma, connective tissue, carcinoid, thyroid, multisite | T1–T9, T11–T16, T18–T27 | No range of lag times specified | Overall survival Recurrence-free survival Mortality Staging |
142/117 studies: no association between longer delays and poorer outcomes | Neal et al., 2015 |
| 91/117 studies: positive association between longer delays and poorer outcomes | ||||||
| 23/117 studies: negative association between longer delays and poorer outcomes (waiting-time paradox) | ||||||
| Some studies found that a longer time to diagnosis and/or treatment was associated with better OS and RFS, while other studies found the opposite. More studies found that shorter times to diagnosis led to better oncologic outcomes in breast, colorectal, head and neck, testicular, and melanoma | ||||||
| Breast, cervical, colorectal, lung | T10 | 29 to 1092 days | Overall survival Tumour size Tumour stage |
Longer wait times associated with a greater risk of poorer clinical outcomes across the breast, cervical, colorectal, and lung cancers | Doubeni et al., 2018 | |
| Limited evidence confirming specific timeframes during which diagnostic testing should be completed after positive screening test | ||||||
-- indicates that cancer type was not specified or applicable to the site.