A major bioethical issue for health care services, patients, and their families is cancer treatment delay, a problem experienced by every health care system worldwide, unfortunately, exacerbated at present with the ongoing COVID 19 pandemic. The first question to address is the potential effect of delays in the treatment of each cancer and the respective prescribed therapy. Many studies have examined this problem, but a recent systematic review and meta-analysis published by the British Medical Journal provides robust evidence to guide national policy-making and inform oncologic decision-makers in hospitals, to ultimately benefit patients and family with this devastating disease.
The British Medical Journal published a study entitled “Mortality due to cancer treatment delay: systematic review and meta-analysis” on November 4, 2020 (read HERE). The article says in the Introduction “The need for an in-depth understanding of the impact of treatment delay on outcomes has come sharply into focus during the coronavirus 2019 (COVID-19) pandemic. Many countries have experienced deferral of elective cancer surgery and radiotherapy, and reductions in the use of systemic treatments because systems have reassigned healthcare resources to pandemic preparedness. The lack of high-quality data on the impact of deferred and delayed cancer treatment has meant that the impact of COVID-19 lockdown measures on patterns of care and subsequent outcomes has not been robustly quantified. More broadly, in non-pandemic times, health systems have developed pathways and targets for intervals from the time of diagnosis to receipt of treatment within National Cancer Control Plan frameworks that do not have a strong empirical basis.”
The urgent necessity to stop death for cancer treatment delay
The authors continue to describe with great precision their aim “Our analysis aims to provide robust evidence to guide national policymaking, specifically the prioritization and organization of cancer services, by investigating the association between delays in receipt of cancer treatment and mortality. We considered seven common cancers and provide estimates on the impact of delay across all three curative modalities: surgery, systemic treatment, and radiotherapy delivered in the radical, neoadjuvant, and adjuvant settings.”
The study clearly defines what means in this case treatment delay “[…] as the time from diagnosis to treatment for the first treatment (definitive surgery or radiation), and from time of surgery to treatment for adjuvant indications (chemotherapy or radiation after surgery). For neoadjuvant treatments (those delivered before primary curative therapy, eg, surgery), the delay was defined as the time from diagnosis to the start of neoadjuvant treatment, or from the end of neoadjuvant treatment to time of surgery. Delay of curative treatments was investigated (surgery, systemic treatment, and radiotherapy).”
Cancer treatment delay a great review
We don’t enter into the methodology of the study only say that they follow a rigorous and clear method. With the subtitle of “Systematic review” they say “We undertook a systematic review to identify high validity studies quantifying the impact of treatment delay on mortality […] To fully assess the validity of included studies, we did not search the literature for studies in abstract form only. Studies were limited to English language publications, from 2000 to the present, and those reporting specifically on treatment delay and survival for the seven cancers being analyzed.[…] We included studies if they specifically reported on the impact of delay for a well-defined cancer indication. […] The research was informed by patient groups and cancer charities that were concerned about the impact of cancer treatment deferral and delays during the covid-19 pandemic.”
They continue “[…] We obtained 275 articles […] These studies included 1 272 681 patients” which gives an idea of the magnitude of the review.
In this sense, another article published in JAMA Oncology on approaches the same issue with the same results warning “Quantitative integration of cancer mortality estimates and data on the consequences of treatment delay is needed to aid treatment decisions and improve patient outcomes.”
The urgent bioethical necessity for improving population-level survival outcomes
The conclusions of the study show the urgent bioethical necessity to avoid more deaths. “The impact of delay on mortality can now be quantified for prioritization and modeling. Even a four-week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimizing system-level delays to cancer treatment initiation could improve population-level survival outcomes.”
Bioethics Observatory – Institute of Life Sciences