This retrospective cohort study used the National Cancer Database (2012–2023) to evaluate trends and predictors of waiting time from diagnosis to first-course therapy (up-front surgery or neoadjuvant therapy) in ~2.73 million patients with nonmetastatic stage I–III breast, colon, lung, pancreatic, gastric, or esophageal cancer who underwent definitive surgical resection.
Median wait times increased significantly across all six cancer types from 2012–2015 to 2022–2023 (e.g., breast: 34→45 days; colon: 20→31 days; lung: 41→53 days; pancreas: 23→32 days; gastric: 35→49 days; esophageal: 38→48 days; all P<.001). Key predictors of longer delays included Medicaid insurance (5/6 cancers), lowest-quartile income (6/6), Black race (5/6), greater travel distance (4/6), care in the West (6/6), treatment at academic institutions (6/6), and use of robotic surgery (5/5 nonbreast cancers).
- Retrospective design using administrative/registry data (National Cancer Database) limits causal inference and may not capture unmeasured confounders. - Full text is under embargo; detailed methodology and multivariable model specifications could not be reviewed. - The 85% female composition reflects heavy representation of breast cancer patients, which may skew overall pooled estimates.
Surgical wait times for major cancers have risen steadily over a decade and are longest at academic centers and for referred, lower-income, or Black patients — clinicians and health systems should proactively track and address these gaps. Robotic surgery adoption is also independently linked to longer delays and warrants operational scrutiny.
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