The gap between a cancer diagnosis and the start of treatment has widened by about 10 days to two weeks over the past decade, depending on the cancer, according to a study of more than 2.7 million American patients published this week in JAMA Surgery.
The analysis, which used the National Cancer Database maintained by the American College of Surgeons, examined patients with stage 1 to 3 breast, colon, lung, gastric, pancreatic or esophageal cancer who were eligible for surgery at diagnosis. Median time from diagnosis to first-course treatment increased for all six of those cancers between 2012 and 2023.
"Across every cancer we studied, patients are waiting longer today than they were a decade ago," Tim Donahue, the study's senior author and a surgical oncologist at the University of California, Los Angeles, told STAT.
The finding lands on a practical anxiety that nearly every newly diagnosed patient recognizes: the stretch of weeks between hearing the word cancer and having something actually done about it.
The Numbers, Cancer by Cancer
The increases were consistent in direction and similar in scale. Comparing the earliest years of the study period with the most recent, reported medians by cancer type rose from 34 days to 45 for breast cancer and from 20 days to 31 for colon cancer. Lung cancer moved from 41 days to 53, pancreatic cancer from 23 to 32, gastric cancer from 35 to 49, and esophageal cancer from 38 to 48.
The share of patients experiencing prolonged delays of 30 days or more and extreme delays of 60 days or more also grew over the study period. The increases held for both patients who went straight to surgery and those who received chemotherapy or radiation before surgery.
Two patterns in the data complicate the intuitive assumption that better hospitals mean faster care. High-volume academic hospitals showed the most significantly prolonged wait times compared with community hospitals. And patients covered by Medicaid, lower-income patients, and Black patients waited longer than others.
Reading a Retrospective Cohort Study Correctly
This is a retrospective cohort analysis, which describes a trend rather than establishing a cause. The design can show how wait times grew and identify which groups experienced the longest waits. It cannot demonstrate that any particular factor produced the increase, and it was not designed to measure whether these specific delays changed survival for these specific patients.
The researchers and independent commentators offered several plausible contributors: a national oncologist shortage, rising cancer incidence, lengthy prior authorization processes, and the growing complexity of multidisciplinary treatment planning. Karl Bilimoria, a surgical oncologist at Indiana University who has published previous research on cancer wait times, pointed to workforce shortages and increasing diagnoses in comments to STAT.
Separate research has examined whether treatment delay affects outcomes, with results that vary substantially by tumor type and stage. Prior analyses have found associations between longer time to treatment and higher mortality in some cancers, while other studies have found no survival effect within particular windows. Those are different questions from the one this study answered, and conflating them would overstate what the new data show.
Some of the increase may also reflect care getting more thorough rather than simply slower. Modern treatment planning routinely involves molecular testing, tumor board review across several specialties, and sequencing decisions about whether chemotherapy or radiation should come before surgery. Each of those steps adds days and can improve the plan.
The Trade-off Between Expertise and Timeliness
That tension is the heart of the accompanying editorial. Stanford School of Medicine surgeons Lia Delaney and Sherry Wren, writing in a commentary published alongside the study, argued that the system's design priorities have consequences.
"Timeliness should be considered a core dimension of healthcare quality," they wrote, adding that the modern oncology system has optimized for specialization rather than speed, and that as cancer care continues to regionalize, efforts to improve quality can create barriers to timely treatment unless capacity and coordination grow alongside. Rather than concentrating all cancer care in referral centers, they argued that network models that keep lower-complexity care closer to home may better balance quality and access.
For a patient, that abstraction becomes a concrete decision. A newly diagnosed person often chooses between a nearby community hospital that can operate sooner and a distant academic center with deeper subspecialty expertise and a longer queue. The study does not tell any individual which to pick. It establishes that the trade-off is real and measurable, not imagined, which is useful information to bring into that conversation.
The disparities finding sharpens the point. Patients on Medicaid, with lower incomes, or who are Black waited longer, and those are the same groups most likely to face transportation barriers, inflexible work schedules, and less administrative help navigating referrals and authorizations. Delay in this data is not distributed randomly.
Practical Steps While Waiting for a Start Date
Patients cannot fix a workforce shortage, but several things are within reach during the interval between diagnosis and treatment.
Asking directly what the expected start date is and what specific steps must happen before then converts an open-ended wait into a checklist. Common bottlenecks include pathology review, imaging, molecular testing results, insurance prior authorization, and tumor board scheduling. Knowing which one is pending tells a patient where to push.
Prior authorization delays, in particular, often respond to attention. Patients can ask their oncology office who is handling the authorization, whether it has been submitted, and whether a peer-to-peer review has been requested if it was denied. Many cancer centers employ patient navigators whose job is precisely this, and asking to be connected with one is reasonable. MedicalDaily has also published a guide to the price information patients can demand before care begins.
Seeking a second opinion is a patient's right and often valuable, but it adds time. Patients who want one should ask whether it can proceed in parallel with the workup rather than sequentially. Anyone whose symptoms worsen significantly while waiting, including new severe pain, bleeding, difficulty swallowing or breathing changes, should contact the oncology team rather than waiting for the scheduled appointment.
What remains unknown is whether this increase has changed survival at the population level, and whether the trend has continued past 2023. The database ends there. Researchers may extend the analysis, and professional societies could respond by treating time to treatment as a formal quality metric, as the editorial urged. Access pressures are building elsewhere in the system too, as MedicalDaily has reported in coverage of adults postponing care until Medicare eligibility. Patients should watch for institutional reporting of wait times, which would let people compare centers on something other than reputation.
Key Questions Answered
What did the study find? Median time from cancer diagnosis to first-course treatment rose by roughly 10 days to two weeks between 2012 and 2023 across six cancer types, in an analysis of more than 2.7 million patients.
Which cancers were studied? Stage 1 to 3 breast, colon, lung, gastric, pancreatic and esophageal cancers in patients eligible for surgery at diagnosis.
Does this prove delays are harming patients? No. It is a retrospective cohort study describing a trend. It was not designed to measure survival effects from these specific delays.
Why would academic hospitals be slower? The study did not establish causes. Researchers and commentators pointed to higher patient volume, more complex multidisciplinary planning, workforce shortages, and prior authorization processes.
Who waited longest? Patients covered by Medicaid, lower-income patients, and Black patients had longer wait times, alongside those treated at high-volume academic centers.
What can a patient do while waiting? Ask for the expected start date and what steps remain, ask who is handling insurance authorization, and ask to be connected with a patient navigator.
When should someone call the oncology team while waiting? If symptoms worsen significantly, including new severe pain, bleeding, trouble swallowing, or changes in breathing.
