Surgical waiting times in patients with high- and low-risk renal cell carcinoma in England

To assess to what extent hospitals meet the uniform English National Health Service 'timely' treatment standard, what happens after a breach, and determinants of delay for patients with high-risk renal cell carcinoma (RCC).

Population-based study using linked data for 7030 patients with high-risk and 10 708 patients with low-risk RCC, 2019-2023. The probabilities of 'timely' treatment and prolonged delay (≤31 days or >62 days from decision-to-treat, respectively) were estimated using multilevel logistic regression. Daily treatment probabilities beyond 31 days were represented using smoothed hazard rates.

For a typical patient with high-risk RCC, timely treatment declined from 83.7% (2019) to 64.8% (2023), with a corresponding decline in the low-risk group from 71.3% to 47.6%, while prolonged delays more than doubled, from 3.9% to 9.4%. Patients with high-risk RCC were prioritised over those with low-risk disease (73.6% vs 58.2%; adjusted risk ratio 1.26, 95% confidence interval 1.22-1.31). Older and more socioeconomically deprived patients experienced longer delays. Once the standard was breached, the daily probability of surgery declined sharply. Adjusted percentages of patients with high- and low-risk RCC treated within the standard were strongly correlated (r = 0.78).

Prioritisation of patients with high-risk RCC was maintained throughout the study period but did not prevent a system-wide decline in timely treatment. Patients who breach the timely treatment standard face diminishing daily probabilities of surgery. Risk-stratified standards, ring-fenced surgical capacity, and monitoring beyond defined timely treatment standards are needed to safeguard patients against delays that have significant prognostic implications.