Delays in time to treatment initiation more common for many cancers

Alok A. Khorana

The time between cancer diagnosis and treatment initiation increased by 38% during a 10-year period, according to study results.

The delay appeared associated with a substantially increased risk for death.

“Physicians need to commit to multidisciplinary care and create integrated practice units that focus on patients,” Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, vice chair for clinical services at Taussig Cancer Institute and director of the gastrointestinal malignancies program at Cleveland Clinic, said in a press release. “Time to treatment initiation needs to be measured and emphasized, and we must understand what is significant to each individual patient and not assume we already know.”

Khorana and colleagues pooled prospective data from the National Cancer Data Base to assess the number of days between diagnosis and first treatment for nearly 3.7 million patients diagnosed with early-stage solid tumor cancers between 2004 and 2013.

Median time to treatment initiation increased significantly during that period, and patients who waited more than 6 weeks to begin treatment achieved demonstrated significantly shorter survival.

HemOnc Today spoke with Khorana about the study, how treatment delays affect patient outcomes, factors that may prolong time to treatment initiation and how those challenges can be overcome.

Question: How did you conduct this study?

Answer: Our study looked at whether the time from diagnosis to treatment matters for patients with cancer and the effects on outcomes. We decided to use a national sample of patients included in the National Cancer Data Base, a prospective database that includes nearly 35% of all patients with cancer in the United States. We evaluated the time from diagnosis to first treatment, such as surgery, radiation therapy or chemotherapy. We also assessed whether delays in time to treatment had an impact on cancer mortality.

Q: What did you find?

A: We found that the time to treatment initiation increased during the past decade, from a median 21 days in 2004 to a median 29 days in 2013. Also, for most early-stage cancers — with the exception of prostate cancer — delays to treatment initiation appeared associated with shorter survival. Mortality risk increased with each week of delay.

Q: Can you describe the emotional impact these delays have on patients?

A: There is no question that patients with cancer who have to wait longer for treatment experience more anxiety and stress. This has been documented. Patients experience anxiety about their cancer diagnoses and are eager to begin treatment. This is completely understandable.

Q: Why is the time to treatment initiation increasing?

A: Cancer care has become more complex, requiring multidisciplinary input and multiple diagnostic tests. In addition, patients and providers are required more often to obtain prior authorizations from insurance companies before scheduling treatments or procedures. Health care systems have become more complex and difficult to navigate. It is likely a mix of all of these factors. However, this is all speculation because we were not able to fully assess this in our study.

Q: How might physicians overcome these challenges to reduce time to treatment initiation?

A: Part of this involves working with insurance companies and trying to get them to override some of the prior authorization requirements. Second, we need to get better at enhancing access to care for patients. Once patients are in the system, we need to help them navigate the system.

Q: What are the next steps?
A: We published a study on reducing time to treatment initiation in patients with colorectal cancer using multidisciplinary clinics at Cleveland Clinic, and we have plans to expand this work to other cancer types. We continue to work on ways to get patients into and through the health care system faster.

Q: What is the take-home message of this study?

A: There is a common perception among physicians that small delays in starting treatment are not impactful on long-term outcomes. However, our findings indicate that delays in starting curative treatment for various early-stage cancers generally appear to be associated with worsened survival. It is incumbent upon physicians, health care systems and insurers to reduce hurdles to access, navigation and initiating treatment so patients have the best possible outcomes. – by Jennifer Southall

Reference:

Khorana AA, et al. Abstract 6557. Presented at: ASCO Annual Meeting; June 2-6, 2017; Chicago.

For more information:

Alok A. Khorana, MD, can be reached at Cleveland Clinic, 10201 Carnegie Ave./CA60, Cleveland, Ohio 44195; email: khorana@ccf.org

Disclosure: Khorana reports consultant roles with Amgen, Bayer, Halozyme, Janssen Scientific Affairs, LEO Pharma, Pfizer, Roche and Sanofi; honoraria from Amgen, Bayer, Halozyme, Janssen, LEO Pharma, Pfizer, Roche and Sanofi; and research funding from Amgen, Janssen Scientific Affairs and LEO Pharma.

Alok A. Khorana

The time between cancer diagnosis and treatment initiation increased by 38% during a 10-year period, according to study results.

The delay appeared associated with a substantially increased risk for death.

“Physicians need to commit to multidisciplinary care and create integrated practice units that focus on patients,” Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, vice chair for clinical services at Taussig Cancer Institute and director of the gastrointestinal malignancies program at Cleveland Clinic, said in a press release. “Time to treatment initiation needs to be measured and emphasized, and we must understand what is significant to each individual patient and not assume we already know.”

Khorana and colleagues pooled prospective data from the National Cancer Data Base to assess the number of days between diagnosis and first treatment for nearly 3.7 million patients diagnosed with early-stage solid tumor cancers between 2004 and 2013.

Median time to treatment initiation increased significantly during that period, and patients who waited more than 6 weeks to begin treatment achieved demonstrated significantly shorter survival.

HemOnc Today spoke with Khorana about the study, how treatment delays affect patient outcomes, factors that may prolong time to treatment initiation and how those challenges can be overcome.

Question: How did you conduct this study?

Answer: Our study looked at whether the time from diagnosis to treatment matters for patients with cancer and the effects on outcomes. We decided to use a national sample of patients included in the National Cancer Data Base, a prospective database that includes nearly 35% of all patients with cancer in the United States. We evaluated the time from diagnosis to first treatment, such as surgery, radiation therapy or chemotherapy. We also assessed whether delays in time to treatment had an impact on cancer mortality.

Q: What did you find?

A: We found that the time to treatment initiation increased during the past decade, from a median 21 days in 2004 to a median 29 days in 2013. Also, for most early-stage cancers — with the exception of prostate cancer — delays to treatment initiation appeared associated with shorter survival. Mortality risk increased with each week of delay.

Q: Can you describe the emotional impact these delays have on patients?

A: There is no question that patients with cancer who have to wait longer for treatment experience more anxiety and stress. This has been documented. Patients experience anxiety about their cancer diagnoses and are eager to begin treatment. This is completely understandable.

PAGE BREAK

Q: Why is the time to treatment initiation increasing?

A: Cancer care has become more complex, requiring multidisciplinary input and multiple diagnostic tests. In addition, patients and providers are required more often to obtain prior authorizations from insurance companies before scheduling treatments or procedures. Health care systems have become more complex and difficult to navigate. It is likely a mix of all of these factors. However, this is all speculation because we were not able to fully assess this in our study.

Q: How might physicians overcome these challenges to reduce time to treatment initiation?

A: Part of this involves working with insurance companies and trying to get them to override some of the prior authorization requirements. Second, we need to get better at enhancing access to care for patients. Once patients are in the system, we need to help them navigate the system.

Q: What are the next steps?
A: We published a study on reducing time to treatment initiation in patients with colorectal cancer using multidisciplinary clinics at Cleveland Clinic, and we have plans to expand this work to other cancer types. We continue to work on ways to get patients into and through the health care system faster.

Q: What is the take-home message of this study?

A: There is a common perception among physicians that small delays in starting treatment are not impactful on long-term outcomes. However, our findings indicate that delays in starting curative treatment for various early-stage cancers generally appear to be associated with worsened survival. It is incumbent upon physicians, health care systems and insurers to reduce hurdles to access, navigation and initiating treatment so patients have the best possible outcomes. – by Jennifer Southall

Reference:

Khorana AA, et al. Abstract 6557. Presented at: ASCO Annual Meeting; June 2-6, 2017; Chicago.

For more information:

Alok A. Khorana, MD, can be reached at Cleveland Clinic, 10201 Carnegie Ave./CA60, Cleveland, Ohio 44195; email: khorana@ccf.org

Disclosure: Khorana reports consultant roles with Amgen, Bayer, Halozyme, Janssen Scientific Affairs, LEO Pharma, Pfizer, Roche and Sanofi; honoraria from Amgen, Bayer, Halozyme, Janssen, LEO Pharma, Pfizer, Roche and Sanofi; and research funding from Amgen, Janssen Scientific Affairs and LEO Pharma.

    See more from ASCO Annual Meeting