{"entity":{"id":"paper-hanna-bmj","kind":"paper","name":"Mortality due to cancer treatment delay: systematic review and meta-analysis","aka":[],"tldr":"Paper cited by one bottleneck page and 18 idea pages, indexed on Europe PMC as PubMed record 33148535 and published in BMJ; the citing pages link this DOI, which is how the record was matched.","summary":"Objective: To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways.\n\nDesign: Systematic review and meta-analysis.\n\nData sources: Published studies in Medline from 1 January 2000 to 10 April 2020.\n\nEligibility criteria for selecting studies: Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models.\n\nResults: The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings.\n\nConclusions: Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. 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 minimising system level delays to cancer treatment initiation could improve population level survival outcomes.\n\nIndexed on Europe PMC as PubMed record 33148535 (DOI 10.1136/bmj.m4087). Matched by DOI alone: one bottleneck page and 18 idea pages cite this DOI among their external links (the pages are listed under Related), and this page was written so that the citation resolves inside OnCo. No figure has been checked by an editor.","asOf":"2026-09-22","links":[{"label":"BMJ 2020","url":"https://doi.org/10.1136/bmj.m4087"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/33148535/"},{"label":"Europe PMC","url":"https://europepmc.org/article/MED/33148535"}],"tags":["europepmc-ingest"],"related":["b-care-fragmentation","idea-acc-portable-treatment-summary","idea-acc-funded-navigator-per-diagnosis","idea-acc-transition-handoff-medication-reconciliation","idea-acc-acute-oncology-assessment-units","idea-acc-universal-asynchronous-second-opinion","idea-acc-tumour-board-implementation-audit","idea-acc-episode-payment-tied-to-concordance","idea-acc-embedded-decision-aids","idea-acc-primary-care-shared-care-agreements","idea-acc-guideline-concordance-dashboards","idea-acc-national-virtual-mdt-rare-complex","idea-acc-one-stop-breast-diagnostic-clinic","idea-acc-reflex-genomic-profiling-at-diagnosis","idea-acc-rapid-diagnostic-centres-vague-symptoms","idea-acc-diagnostic-interval-public-registry","idea-acc-financial-toxicity-screening-at-diagnosis","idea-acc-pathway-capacity-simulation","idea-acc-reflex-biomarker-panels-by-tumour"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["bmj"],"dependsOn":[],"notes":[],"journal":"BMJ","year":2020,"doi":"10.1136/bmj.m4087","pmid":"33148535","authors":"Hanna TP, King WD, Thibodeau S, et al.","paperType":"meta-analysis","findings":[],"whatItMeans":"One bottleneck page and 18 idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.","caveats":["Matched to the citing OnCo records by DOI alone; the summary reproduces the Europe PMC abstract and no figure has been verified against the full paper."]},"route":"/key-papers/paper-hanna-bmj/","neighbours":{"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"}],"idea":[{"id":"idea-acc-portable-treatment-summary","kind":"idea","name":"A machine-readable treatment summary handed to every patient and readable by any hospital","route":"/ideas/idea-acc-portable-treatment-summary/"},{"id":"idea-acc-funded-navigator-per-diagnosis","kind":"idea","name":"A paid patient navigator for every new cancer diagnosis, reimbursed as a service","route":"/ideas/idea-acc-funded-navigator-per-diagnosis/"},{"id":"idea-acc-transition-handoff-medication-reconciliation","kind":"idea","name":"A standard handoff with medication reconciliation at every cancer care transition","route":"/ideas/idea-acc-transition-handoff-medication-reconciliation/"},{"id":"idea-acc-acute-oncology-assessment-units","kind":"idea","name":"Acute oncology assessment units so sick cancer patients bypass the emergency department","route":"/ideas/idea-acc-acute-oncology-assessment-units/"},{"id":"idea-acc-universal-asynchronous-second-opinion","kind":"idea","name":"An asynchronous expert second opinion for every new advanced-cancer diagnosis","route":"/ideas/idea-acc-universal-asynchronous-second-opinion/"},{"id":"idea-acc-tumour-board-implementation-audit","kind":"idea","name":"Audit whether tumour board recommendations were actually carried out","route":"/ideas/idea-acc-tumour-board-implementation-audit/"},{"id":"idea-acc-episode-payment-tied-to-concordance","kind":"idea","name":"Bundled episode payments for cancer care with bonuses for guideline concordance","route":"/ideas/idea-acc-episode-payment-tied-to-concordance/"},{"id":"idea-acc-embedded-decision-aids","kind":"idea","name":"Decision aids built into the record for every preference-sensitive cancer choice","route":"/ideas/idea-acc-embedded-decision-aids/"},{"id":"idea-acc-primary-care-shared-care-agreements","kind":"idea","name":"Formal shared-care agreements between oncology and family doctors, with same-day e-consult","route":"/ideas/idea-acc-primary-care-shared-care-agreements/"},{"id":"idea-acc-guideline-concordance-dashboards","kind":"idea","name":"Live guideline-concordance dashboards for every tumour board, generated from the record","route":"/ideas/idea-acc-guideline-concordance-dashboards/"},{"id":"idea-acc-national-virtual-mdt-rare-complex","kind":"idea","name":"Mandatory national virtual tumour boards for rare and complex cancers","route":"/ideas/idea-acc-national-virtual-mdt-rare-complex/"},{"id":"idea-acc-one-stop-breast-diagnostic-clinic","kind":"idea","name":"One-stop breast clinics: imaging, biopsy and a preliminary answer in a single visit","route":"/ideas/idea-acc-one-stop-breast-diagnostic-clinic/"},{"id":"idea-acc-reflex-genomic-profiling-at-diagnosis","kind":"idea","name":"Pathologists order genomic profiling automatically at diagnosis of advanced cancer","route":"/ideas/idea-acc-reflex-genomic-profiling-at-diagnosis/"},{"id":"idea-acc-rapid-diagnostic-centres-vague-symptoms","kind":"idea","name":"Rapid diagnostic centres for people with vague but worrying symptoms","route":"/ideas/idea-acc-rapid-diagnostic-centres-vague-symptoms/"},{"id":"idea-acc-diagnostic-interval-public-registry","kind":"idea","name":"Record and publish the symptom-to-diagnosis interval for every cancer, by hospital","route":"/ideas/idea-acc-diagnostic-interval-public-registry/"},{"id":"idea-acc-financial-toxicity-screening-at-diagnosis","kind":"idea","name":"Screen every patient for financial hardship at diagnosis and connect them to help","route":"/ideas/idea-acc-financial-toxicity-screening-at-diagnosis/"},{"id":"idea-acc-pathway-capacity-simulation","kind":"idea","name":"Simulate each hospital's cancer pathway as a queue to find and remove the waits","route":"/ideas/idea-acc-pathway-capacity-simulation/"},{"id":"idea-acc-reflex-biomarker-panels-by-tumour","kind":"idea","name":"Standing reflex biomarker panels per tumour type, run without an oncologist's order","route":"/ideas/idea-acc-reflex-biomarker-panels-by-tumour/"}],"journal":[{"id":"bmj","kind":"journal","name":"BMJ","route":"/journals/bmj/"}]}}