This transcript has been edited for clarity.
Hello, this is Karol Sikora, Professor. I am an oncologist here in London. And what I want to do today is to see the paper that appeared yesterday. The· British Medical Journal, Find out the mortality rate due to delayed cancer treatment. It’s a meta-analysis. This is done by a group at Queen’s University in Kingston, Ontario, the London School of Hygiene and Tropical Medicine (LSHTM), and King’s College London.
The main driving force for this was Ajay Aggarwal, an associate professor at LSHTM who was once my registrar, and I think he was a very bright person. Undoubtedly, he did a good job with his colleagues in analyzing very complex problems.
Not urgent
Delays in cancer treatment are bad. What we don’t know is how much delay is acceptable.
Obviously not an emergency.It’s not like Myocardial infarctionStenting should be done within a few hours for maximum effect to save the problematic myocardium. In the case of cancer, we assume that you can probably wait a month, perhaps two months, before rushing into treatment.
And it is the basis of diagnostic and staging systems around the world. You don’t have to hurry.
Very interestingly what this paper is doing, it goes through world literature-and I’ll be back to it soon-and look at the results of the four-week delay.
For me now, four weeks aren’t here or there, and I’m not too worried. But in fact, this paper shows that you need to worry about delays of only four weeks. It is very appropriate to come at the time of COVID-19, where a 4-week delay in cancer services around the world has become very common, mainly because the system failed at the end of the diagnosis.
Also, patients are slowing forward because primary care is not always able to deal with them.
Meta-analysis
Now let’s see what happened. They took publications in a span of 20 years between 2000 and 2020. And I collected and analyzed them all. And in fact, they have collected a huge number of publications like 2843. I narrowed it down to 275. After investigating the robustness of the data and its effects, we narrowed it down to 34 papers.
And they were looking for a full range of cancers, they examined seven cancers, and the cancers they examined were the colon, lungs, cervix, including the bladder, breast, rectum, and Head and neck cancer..
And what they were looking for in these 34 studies was an association between delayed onset of treatment and mortality at a later stage. So this is a pretty exclusive thing to look for.
The delay could be in surgery, which was common during the April pandemic when all UK cancer services were still functioning, but it was difficult to get into the system and opening the diagnostic path It was difficult.
And they also noted delays in chemotherapy, systemic therapy, and radiation therapy.
The quality of the data is highly variable, as it is not currently collected specifically to investigate the impact of a 4-week delay on mortality. And that is the weakness of research. And there is nothing you can do about it. The strength of meta-analysis is that it provides a large number. There are 1.2 million patients in this study.
Of course, its weakness is that it is not pre-designed to answer the questions we want. What is the result of the 4-week delay in this case?
“Crushing”
Now, let’s go to the survey results. They noted an increased risk of death for almost all of these indications. And with a 4-week delay, it turned out to be an increase of 6% to 8%.
This is pretty crushing. This means that, as is often said in current services, the 62-day goal, the 31-day goal, etc. are well beyond 4 weeks.
Therefore, we operate on the inherited system. In other words, there is no urgency in treating cancer.
So the other things they found if they had a 12 week surgical delay breast cancer, You have a much greater risk of death, and if there is a 12 week delay, it will rise up to 26%.
This is a very good match for the data published in. Lancet From a group in London in July of this year that looked at monthly delays and how they affect overall survival.
The difference between the two studies is that this study is a meta-analysis of existing literature. Lancet The paper was basically a very sophisticated back-of-the-envelope calculation of what would have happened if the monthly delay was increased from 1 month to 6 months across various cancers.
The problem is that different cancers grow at different rates. Different cancers have different spread pathways and different levels. Invasion.. Therefore, it is not possible to predict what the delay will cause for an individual patient.
I thought paper was good. That was the best thing you could do with your data. And the conclusion is that a 4-week delay in treatment is associated with an increase in mortality in all common forms of cancer treatment, and longer delays are increasingly detrimental, which seems to be a fair conclusion. ..
Why didn’t they choose Prostate cancer?? Of course, it was excluded because most people are in a very different situation without delay. They are actually receiving hormone therapy. Therefore, there is no delay in treatment. When they reach an oncologist or urologist, they are placed directly on hormone therapy.
Also, the nature of prostate cancer is very different. It is slow-growing, lazy, and tends to last for years, even in patients with metastatic cancer. So it’s not a good cancer to see.
However, there was significant consistency across all 34 papers, showing that four weeks was bad news for cancer patients.
Why is Britain so slow?
What does this mean? As you know, what I’ve lived with for the past 30 years is the fact that the UK has poor overall cancer survival data, but it’s not perfect for leukemia, embryonic cell tumors, and childhood cancer. , And complex cancers. But for common cancers.
When you get cancer, it cannot be the quality of care that makes a difference. There is no magic drug that is causing changes in survival. The pharmaceutical industry may want to say, well, the UK isn’t spending enough on chemotherapy, and that’s why the results are bad, but that’s not the real reason.
The real reason should be an early delay. Delayed start of treatment. In the UK, the 1-year survival rate has been found to be significantly lower than in other European countries and higher than the 5-year or 10-year survival rate.
This indicates that many patients appear late and present with high-stage cancer, while European colleagues see low-stage cancer. And that will explain the difference.
Therefore, the problem here is diagnostics. It is not actually treated. If you find out that you have cancer, you will receive a histology report from a biopsy, and an image report from MRI, PET CT, CT, etc., and you will start your business. For cancer treatment. And usually the delay is small.
The delay occurs when all diagnostic packets reach the processed phase, MDT. [multi-disciplinary team] Decide on treatment and you move forward.
And that’s what we need to work on. In France, Germany and Italy, you can get a CT within a week using COVID-19. Here it’s much slower to get it unless you call, unless you know you have cancer.
So move forward. I think this is an interesting study. Let’s see more. We need to look at the years of lost life. I have a lot of questions about this.
Will it change the way cancer services operate? I hope so. I don’t think it’s urgent. You don’t need to be treated the day the cancer is diagnosed, but you really need to be smart about your prior diagnostic pathways. If we overcome COVID, I think some of it will progress from next year to two years. -19 problems.
This is Carol Sikola. Please let us know what you think. Thank you very much.
