The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature

Zheng, Chen; King, Will D.; Pearcey, R.; Kerba, Marc; Mackillop, William J.

doi:10.1016/j.radonc.2007.11.016

Cited by 350 publications

(278 citation statements)

References 73 publications

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“…If treatment is delayed the probability of survival may be reduced. 4,7,[10][11][12][13] A limited number of serial pretreatment imaging studies have been undertaken in NSCLC patients who are candidates for potentially curative therapy. In a significant study, O'Rourke and Edwards reported that 21% of 29 candidates for radical RT developed incurable disease progression (median 54 days) between diagnostic/ staging and RT planning computed tomography (CT) scans.…”

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confidence: 99%

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

Everitt

Herschtal

Callahan

et al. 2010

Cancer

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BACKGROUND:The authors studied growth and progression of untreated nonsmall cell lung cancer (NSCLC) by comparing diagnostic and radiotherapy (RT) planning fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans before proposed radical chemo-RT. METHODS: Patients enrolled on a prospective clinical trial were eligible for this analysis if they underwent 2 pretreatment whole body FDG-PET/CT scans, >7 days apart. Scan 1 was performed for diagnosis/disease staging and scan 2 for RT planning. Interscan comparisons included disease stage, metabolic characteristics, tumor doubling times, and change in treatment intent. RESULTS: Eighty-two patients underwent planning PET/CT scans between October 2004 and February 2007. Of these, 28 patients (61% stage III, 18% stage II) had undergone prior staging PET/CT scans. The median interscan period was 24 days (range, 8-176 days). Interscan disease progression (TNM stage) was detected in 11 (39%) patients. The probability of upstaging within 24 days was calculated to be 32% (95% confidence interval [CI], 18%-49%). Treatment intent changed from curative to palliative in 8 (29%) cases, in 7 because of PET. For 17 patients who underwent serial PET/CT scans under standardized conditions, there was a mean relative interscan increase of 19% in tumor maximum standardized uptake value (SUV) (P ¼ .022), 16% in average SUV (P ¼ .004), and 116% in percentage injected dose (P ¼ .002). Estimated doubling time of FDG avid tumor was 66 days (95% CI, 51-95 days). CONCLUSIONS: Rapid tumor progression was detected in patients with untreated, predominantly stage III, NSCLC on serial FDG-PET/CT imaging, highlighting the need for prompt diagnosis, staging, and initiation of therapy in patients who are candidates for potentially curative therapy. Cancer 2010;116:5030-7.

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confidence: 99%

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

Everitt

Herschtal

Callahan

et al. 2010

Cancer

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“…Affluent to extremely affluent Americans enjoyed shorter waits, but typically their waits were only one (surgery) to four (RT) weeks shorter than those of their Canadian counterparts. This difference is probably clinically insignificant for most patients as waits of that magnitude were not significantly related to survival in this study nor in previous ones (Chen et al, 2008a(Chen et al, , 2008bHershman et al, 2006). Moreover, the implementation of federal and provincial government wait time guarantees for many services including cancer treatments suggests that cancer survival in Canada is likely to become even more equitable in the future (Cancer Care Ontario, 2009).…”

Section: Discussionmentioning

confidence: 57%

“…Long wait criteria of 2 months for surgery and 3 months post-lumpectomy for radiation therapy were used. Previous research suggested that such waits may be associated with disease recurrences, metastases and shorter survival (Chen et al, 2008b;Hershman et al, 2006;Lund et al, 2008). All breast cancer cases were followed until January 1, 2006 allowing, minimally, for the analysis of 5-year survival.…”

Section: Extremely Poor and Extremely Affluent Neighborhoods-statisticsmentioning

confidence: 99%

Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

et al. 2010

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This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, nonreceipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian breast cancer care advantages.

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“…This is confirmed by the results of audits in breast and lung cancer described above (Robinson et al, 2003;Devbhandari et al, 2007). A recent systematic review of delays in radiotherapy has concluded that there is no threshold below which delay is safe and that radiotherapy should be administered as soon as reasonably achievable (Chen et al, 2008). This conclusion also seems reasonable for systemic therapy but there is no evidence to support it.…”

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confidence: 69%

Waiting times for systemic cancer therapy in the United Kingdom in 2006

et al. 2008

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This audit was conducted to measure waiting times for systemic cancer therapy across the United Kingdom. All patients, aged 16 years or older, commencing their first course of systemic therapy between 13 November and 19 November 2006 were eligible for inclusion. Data on 936 patients from 81 hospital sources were collected. Systemic therapy is largely given in compliance with national waiting time targets. In terms of the Joint Council for Clinical Oncology (JCCO) targets, 84% of patients commence treatment within 21 days and 98% of patients complied with the Department of Health target that treatment should follow within 31 days of the decision being agreed with the patient. Only 76% complied with the Department of Health 62-day target from GP referral to first definitive treatment. However, the date of urgent referral by the GP was not submitted for most patients in our survey, leaving a sample of only 84 out of 936 patients (9% of total) suitable for this analysis. There was only a 3- to 5-day difference between the waiting times for systemic therapy for patients categorised as urgent compared with routine. Locally agreed definitions had little impact on patients' priority for treatment. This audit has established a baseline measurement of waiting times for systemic therapy across the United Kingdom. The continuing introduction of novel therapies is likely to have a significant effect on the service and we recommend that service managers model the likely impact on resource requirements. In addition, urgent treatment should be clearly defined as that required within 24 h (maximum 48 h) to avoid the risk of clinical deterioration, particularly in patients with acute leukaemia, lymphoma or germ cell tumour.

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The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature

Cited by 350 publications

References 73 publications

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

High rates of tumor growth and disease progression detected on serial pretreatment fluorodeoxyglucose‐positron emission tomography/computed tomography scans in radical radiotherapy candidates with nonsmall cell lung cancer

Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

Waiting times for systemic cancer therapy in the United Kingdom in 2006

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