Sooner rather than later

Not infrequently, I have had patients who asked “Can I have this operation later?” after being told that they have a tumour in their liver or colon. My usual first response is “Sooner rather than later. A delay of a few weeks may be alright but not a few months.” As any operation has its attendant mortality risk, it is reasonable for a patient to want some time in order to think things over or to sort out a few things at work and / or at home before undergoing the procedure. So how much delay is acceptable? Is there a critical cut off time for treating cancer?

Researchers from the Aarhus University Hospital in Denmark studied 740 patients diagnosed with colorectal cancer (Br J Surg 2009; 96: 1183 – 1189). There were 458 patients with colonic cancer and 282 rectal cancer patients. The researchers were examining the association between therapeutic delay and survival. Three types of delay were studied: total therapeutic delay – the interval from symptom onset to treatment initiation; provider delay – the interval from first physician contact until treatment initiation and hospital delay – the interval from referral to a hospital until treatment initiation. In colonic cancer patients, the median total therapeutic delay (116 days), provider delay (52 days) and hospital delay (28 days) had no impact on survival in the 458 patients. However, in the rectal cancer group, the study found that a total therapeutic delay of 60 days or more was associated with a 69% increased risk of mortality. In this group, the median total therapeutic delay was 134 days, 49 days for provider delay and the hospital delay was 28 days. The study also found that provider and hospital delay had no impact on the survival of rectal cancer patients. The study showed that early diagnosis of rectal cancer has a significant impact on survival. The longest delay was patient delay – due to non-recognition of symptoms and presenting to the general practitioner late.

The above study highlights the importance of receiving prompt treatment after the onset of symptoms in order to reduce the risk of dying. One cannot find a “Time-table of acceptable delays in initiating treatment” for the different type of cancers. I believe most doctors will adhere to the principle of “Sooner rather than later” when it comes to treating an illness. I strongly urge all patients to subscribe to the same principle too.