Retrospective cohort study of national trends and predictors of waiting times for cancer surgery in the United States

As cancer care becomes increasingly complex, patients may experience prolonged delays between diagnosis and definitive surgical management. Consolidation and expansion of health systems, along with centralization of care, may further amplify these delays. A retrospective cohort study using the National Cancer Database (2012-2023) evaluated national trends and predictors of delay from diagnosis to first-course therapy (upfront surgery or neoadjuvant therapy followed by surgery) in patients with nonmetastatic breast, colon, lung, pancreatic, gastric, or esophageal cancer. A total of 2 731 059 patients were identified. From 2012 to 2023, median time from diagnosis to first-course therapy increased across all malignancies with more than 10 days (p <0.001 for all) and among both patients undergoing upfront surgery and those receiving neoadjuvant therapy prior to surgery. Delays were more pronounced at academic compared with community hospitals. Predictors of longer waiting time included Medicaid insurance, lowest-quartile income, Black race, increased travel distance, and treatment at academic institutions. The authors conlude that among patients undergoing cancer surgery in the USA, waiting times to initiation of first-course therapy have steadily increased since 2012, particularly at high-volume academic centers.