Time to Treatment Initiation for the 30 Most Prevalent Cancer Types: Trends and Predictors of Change

As the complexity and need for cancer care services continue to grow, time to treatment initiation (TTI) has been increasing across cancer types. Presently there are no comprehensive analyses identifying the recent changes in TTI and the important variables causing variation in TTI for all the most prevalent cancer types.

This is a retrospective, observational study using data from the National Cancer Database from 2004 to 2015. The database was queried for newly diagnosed patients with cancer stages I-IV who had TTI within 0-180 days. Stepwise linear regression models were used as a variable selection technique to identify the most significant independent variables to evaluate as predictor variables.

The study sample included 5,615,193 patients (median age, 65; 51.5% female; 86.1% White) across 30 different cancer types (most prevalent: breast [22.1%], lung [18.8%], prostate [16.6%]). The median [IQR] TTI across all 30 cancer types was 26 [6-47] days, with an increase of 7 days from 2004 (21 [4-44]) to 2015 (28 [9-49]; P < .001). No individual cancer type decreased in TTI from 2004 to 2015. The proportion of patients diagnosed with new stage I disease increased by 52.2% from 2004 (28.4%, n = 78,732) to 2015 (43.2%, n = 256,150). All other stages decreased in percent incidence. There was a 100.0% increase in median TTI for stage I patients from 2004 to 2015 (14-28 days). Cancer stage was the most important predictor of change in TTI for 16 cancer types (P < .001 for all 16).

TTI is increasing for patients with cancer, and the recent increase in stage I diagnoses is highly associated with this change.