Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review.
BACKGROUND
It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations.


METHODS
Systematic review of the literature and narrative synthesis.


RESULTS
We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma.


CONCLUSIONS
This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
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RD
Neal
Department of Health Sciences, University of York, York, YO10 5DD, UK.
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P
Tharmanathan
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
B
B
France
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
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NU
Din
Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK.
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S
Cotton
Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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J
Fallon-Ferguson
University of Exeter Medical School, Exeter EX1 2LU, UK.
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W
Hamilton
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
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A
Hendry
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
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M
Hendry
Department of Health Sciences, University of York, York, YO10 5DD, UK.
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R
Lewis
Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK.
U
U
Macleod
Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
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ED
Mitchell
Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK.
M
M
Pickett
North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
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T
Rai
Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
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K
Shaw
School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK.
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N
Stuart
Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark.
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ML
Tørring
North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK.
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C
Wilkinson
Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
B
B
Williams
1] North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK [2] North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK.
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Williams
1] Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia [2] General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia.
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Emery
D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D061665:Time-to-Treatment / Q000706:statistics & numerical data*