Ang Song Peng, Lee Eunseuk, Chia Jia Ee, Iglesias Maya, Di Vanna Mariela, Shambhavi Shreya, Iglesias Jose
Department of Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, AZ, USA.
World J Oncol. 2025 Jun;16(3):286-294. doi: 10.14740/wjon2584. Epub 2025 Jun 14.
Delays in cancer treatment initiation can significantly impact survival outcomes, but the magnitude of this effect varies by cancer type, stage, and patient demographics. This study examined the association between time-to-treatment initiation (TTI) and all-cause mortality across multiple common cancers, evaluating differential impacts and sociodemographic disparities.
A retrospective cohort analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER) database, including 991,771 adults diagnosed with breast, lung, prostate, or colorectal cancers between 2015 and 2020. TTI intervals were divided into four categories: 0 - 1, 2 - 5, 6 - 9, and ≥ 10 months. Cox proportional hazards models, adjusted for demographic, socioeconomic, cancer-specific, and treatment factors, assessed the impact of TTI on all-cause mortality, accounting for time-varying covariates.
Overall, 63.9% of patients initiated treatment within 1 month. Unadjusted analyses revealed paradoxically lower mortality with longer TTI intervals (26.1% for 0 - 1 month vs. 11.4% for ≥ 10 months). After adjusting for time-varying effects, longer TTI significantly correlated with higher mortality risks (hazard ratio (HR): 1.02 for 2 - 5 months, 1.08 for 6 - 9 months, 1.23 for ≥ 10 months; P < 0.001 each), compared to treatment within 1 month. Older age (HR: 1.06), male gender (HR: 1.08), unmarried status (HR: 1.06), and non-Hispanic Black race (HR: 1.03) were independently associated with increased mortality. Lung cancer patients had significantly higher mortality than breast, prostate, and colorectal cancers (all P < 0.001). Treatment differences emerged, with reduced chemotherapy (40.2% to 10.0%) and surgical interventions (70.6% to 48.8%) at longer intervals.
Our analysis showed that increased TTI is independently associated with significantly higher all-cause mortality across major cancers, emphasizing the urgency of timely treatment initiation. Sociodemographic disparities in TTI and outcomes highlight systemic barriers disproportionately affecting vulnerable populations, necessitating targeted interventions to improve equitable cancer care and survival outcomes.
癌症治疗开始的延迟会显著影响生存结果，但这种影响的程度因癌症类型、阶段和患者人口统计学特征而异。本研究调查了多种常见癌症的治疗开始时间（TTI）与全因死亡率之间的关联，评估了不同的影响以及社会人口统计学差异。
使用监测、流行病学和最终结果（SEER）数据库进行了一项回顾性队列分析，纳入了2015年至2020年间被诊断为乳腺癌、肺癌、前列腺癌或结直肠癌的991,771名成年人。TTI间隔分为四类：0 - 1个月、2 - 5个月、6 - 9个月和≥10个月。Cox比例风险模型在对人口统计学、社会经济、癌症特异性和治疗因素进行调整后，评估了TTI对全因死亡率的影响，并考虑了随时间变化的协变量。
总体而言，63.9%的患者在1个月内开始治疗。未经调整的分析显示，TTI间隔较长时死亡率反而较低（0 - 1个月为26.1%，≥10个月为11.4%）。在对随时间变化的效应进行调整后，与1个月内开始治疗相比，较长的TTI与较高的死亡风险显著相关（风险比（HR）：2 - 5个月为1.02，6 - 9个月为1.08，≥10个月为1.23；P均<0.001）。年龄较大（HR：1.06）、男性（HR：1.08）、未婚状态（HR：1.06）和非西班牙裔黑人种族（HR：1.03）与死亡率增加独立相关。肺癌患者的死亡率显著高于乳腺癌、前列腺癌和结直肠癌患者（P均<0.001）。出现了治疗差异，间隔较长时化疗（从40.2%降至10.0%）和手术干预（从70.6%降至48.8%）减少。
我们的分析表明，在主要癌症中，TTI增加与显著更高的全因死亡率独立相关，强调了及时开始治疗的紧迫性。TTI和结果方面的社会人口统计学差异凸显了对弱势群体影响 disproportionately 的系统性障碍，需要有针对性的干预措施来改善公平的癌症护理和生存结果。
