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Survival Better Among Endometrial Cancer Patients Whose Treatment is Delayed

Scottish women who had to wait the longest for treatment of their endometrial cancer have had the highest rates of survival.

This is paradoxical, admits Dr. Simon Crawford and colleagues at the Department of Gynaecological Oncology, Stobhill Hospital, Glasgow, Scotland. "The traditional view is that delay caused by organizational defects has an adverse effect on the disease: this influences survival. Our study suggests that disease influences delay, and so delay is a confounding factor."

One key may be how the family relays information to the relevant hospital oncologist, and how the oncologist interprets it.

Few studies have linked delay in treatment with survival, the researchers note, although a study from Israel found that survival from endometrial cancer was not affected by a delay in treatment of four months.

Researchers collected data from the case notes of 703 women resident in Scotland who were diagnosed between January 1, 1996 and December 31, 1997 as having endometrial cancer.

Calculations were then made of the time between referral to a hospital oncologist and the time of clinic appointments, investigations, and surgery.

Each woman in the study was allocated an International Federation of Gynecology and Obstetrics (FIGO) stage of their disease. The median interval from referral to definitive operation varied from 46 to 81 days (74 to 287 days).

Dr Crawford and colleagues found that delay and survival were inversely related: women with the shortest delay had more advanced disease and survival was least likely among this group of patients.

This interaction is partially accounted for by the relation between stage and delay, the researchers add. However, a hazards model corrected for age, stage, and use of radiotherapy, again shows it is only partly explained by the FIGO stage category.

The fact that the strongest effect between delay and survival is seen in the interval between referral and the first hospital visit, suggests that the way family doctors communicate information to hospital oncologists may be crucial.

Dr Crawford and colleagues said the communication apparently ensures that the oncologists respond faster to patients who are at higher risk. Oncologists "seem to be able, from first clinic visit, to differentiate patients at greater risk and to ensure that cancer is diagnosed and treated faster."

Women with the longest delays have the best survival, and vice versa, suggesting that the "healing art" remains an important but elusive factor, they conclude.
BMJ 2002;325:196.

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