title: Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer.
abstract: BACKGROUND
  Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival.
  
  
  METHODS
  Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years.
  
  
  RESULTS
  For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1-4 after diagnosis were 2.65 (1.50-4.70) and 1.91 (1.06-3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient's residence and the hospital performing surgery, and the patient's income status were associated with delayed surgery.
  
  
  CONCLUSIONS
  Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care.
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.forename: Juhee
authors.initials: J
authors.lastname: Cho
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Seung Sik
authors.initials: SS
authors.lastname: Hwang
authors.forename: Belong
authors.initials: B
authors.lastname: Cho
authors.forename: Jae Hwan
authors.initials: JH
authors.lastname: Oh
authors.forename: Ki Wook
authors.initials: KW
authors.lastname: Jung
authors.forename: Hong Gwan
authors.initials: HG
authors.lastname: Seo
authors.forename: Jong Hyock
authors.initials: JH
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000601:surgery; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000601:surgery; D018265:Carcinoma, Papillary, Follicular / Q000401:mortality / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000401:mortality / Q000601:surgery*; D013997:Time Factors