Wait for Diagnostic Testing and Effect on Outcomes in Patients With Cancer
The longer patients with a positive screening result wait for diagnostic testing, the worse their cancer outcomes may become, according to a literature review of breast, cervical, colorectal, and lung studies published by Doubeni et al in CA: A Cancer Journal for Clinicians led by researchers at the Perelman School of Medicine at the University of Pennsylvania. The authors, an interdisciplinary team of cancer experts from the Population-Based Research Optimizing Screening Through Personalized Regimens Consortium, urge patients who receive a positive screening to schedule a diagnostic test as soon as feasible.
Articles considered for the review were published between January 1998 and December 2017, conducted in an average-risk population (except in lung cancer), and used study designs that provided empirical evidence and evaluated the key question.
Although the findings of this research follow long-standing conventional wisdom, this literature review backs up this message with patient outcome data. The authors make clear that each patient’s cancer trajectory is different, and there is no established time frame recommended for waiting before a diagnostic test without risk of cancer progression.
“To ignore these findings is not patient-centered,” said lead author Chyke Doubeni, MD, Chair of Family Medicine and Community Health at Perelman. “The longer patients wait, the less likely they are to get the diagnostic testing done. There is also the risk that precancerous or early tumors will become more advanced cancers that are more difficult or impossible to cure.”
Suggested Targets
The paper offers suggested targets for each of the four cancers within which diagnostic testing should be performed. The targets range from 60 to 90 days, but the investigators were not able to ascribe a certain number of risk points based on exactly how long a patient waits. For example, on average, cervical cancer takes longer to progress than lung cancer does, but the authors caution against ascribing a safe period to wait or saying it’s safe to wait a little longer if you have cervical cancer vs another type, based on the limited body of knowledge to date.
The National Academy of Medicine has identified improvement in the timeliness and patient-centeredness of care as an important unmet health priority. Screening is proven to reduce the risk of death from some cancers and is currently recommended at grade A or B by the U.S. Preventive Services Task Force in eligible persons for breast, cervical, colorectal, and lung cancers, which enables full coverage of those services under the Affordable Care Act.
Dr. Doubeni and his colleagues note that prompt diagnostic testing may also reduce mortality risk and may reduce worries about uncertainty associated with the procedure. Additionally, sooner is better, as provider or system delays in follow-up may increase the likelihood that diagnostic testing may not occur at all, for example, due to changes in patient contact information or insurance coverage changes.
Next steps for the research will seek out the most effective interventions to reduce the time to diagnosis for vulnerable and minority populations and any patients who have barriers to timely follow up.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
