Start treatment within three days of diagnosis, or accept a worse risk of the cancer spreading. That is the blunt message in a study from Indiana University School of Medicine on bowel cancer. It is also more specific than the headlines made it sound, and the catch, on closer reading, is in who the numbers apply to.
The research, led by corresponding author Chi M. Nguyen and published in JAMA Network Open, drew on insurance claims for 11,927 US adults aged at least 40. Each had a fresh bowel cancer diagnosis, with no spread at that point, and each went on to curative-intent surgery. They were diagnosed between 1 January 2017 and 31 December 2021. Over three years, 12.1% developed metastases.
What the delay cost
The clearest signal came from patients who needed surgery followed by chemotherapy, the typical route. Compared with those who began within three days, patients who waited 4 to 46 days faced a 27% higher risk of metastasis, according to the Daily Mail’s account of the findings. For those who waited 47 days or more, the risk was 55% higher. The ASCO Post, which also covered the paper, lists the same two thresholds.
The picture shifts by pathway. Among patients given chemotherapy before surgery, a wait of 68 days or longer was linked to a hazard ratio of 2.66, almost triple the risk. For those who had surgery and then radiation, waits of 223 days or more pointed to higher risk, but the link did not reach statistical significance. For patients given the full sequence of chemotherapy, surgery and further treatment, no connection showed up at all. The authors argue that this favors thresholds set per pathway over a single universal deadline.
They are cautious about the cause. The Daily Mail reported that the researchers think patients who are not seen promptly may slip through the gaps into fragmented care, and that a literal biological clock is unlikely to explain the gap. “Six to seven weeks of delays were consequential for patients requiring surgery and adjuvant chemotherapy,” the investigators wrote.
England’s target
Here the mechanics become institutional. In England, NHS patients are meant to start cancer treatment within two months of diagnosis. The latest figures show the goal is met for only around 70% of patients. A system that reaches that benchmark for seven in ten is far from starting everyone within three days.
The timing matters more as bowel cancer turns up in younger people. In the UK, over 2,400 people younger than 50 now get the diagnosis annually, a rise of around 25% across a decade. When the disease is found early, 93% of patients survive at least five years. Caught late, the figure falls to 59%.
The study did not test the NHS, and its patients were all insured Americans. What it does give health services is a measuring stick: 47 days is where the measured risk rose to 55%.
Sources
- Major treatment flaw could be fuelling explosion in bowel cancer deaths among under 50s, study suggests – as cases continue to climb | Daily Mail Online
- Treatment Delays May Increase Metastasis Risk in Nonmetastatic Colorectal Cancer – The ASCO Post
