Time to treatment start as a survival predictor for reproductive system cancer: a population-based study

Objective: To evaluate the effect of the time from morphological confirmation of the diagnosis to the start of specialized treatment (time to treatment start: TTS) on cancer-specific survival (CSS) of patients with cancer of the female reproductive system (CFRS) using the data from the regional cancer registry of the Arkhangelsk region (ARCR) over the period 2000 to 2022. Material and methods. depersonalized data on all cases of breast (BC), cervical (CC), corpus uteri (CUC) and ovarian (OC) cancers were obtained from the ARCR for the period 2000–2022. We compared survival with TTS of 0–7 days (recommended by the state guarantee program), 2–4, 5–8, 9–12 weeks, and 3–6, 7–12 months. Cancer-specific survival was calculated using the life tables and Kaplan-Meier methods. The Cox proportional hazard model was used to correct for other prognostic factors. Results. A total of 19321 cases were analyzed. The ministerial recommended TTS of ≤7 days was observed in 61.9 %, 28.5 %, 27.3 % and 55.9 % of patients with BC, CC, CUC and OC, respectively. the five-year CSS for BC, CC, CUC and OC was 73.9 %, 66.5 %, 73.0 % and 52.1 %, respectively. The TTS of ≤7 days compared to longer TTS was associated with the highest 5-year CSS rate in breast cancer (74.3 vs 45–4-67.0 %) and CC (80.2 vs 63.1–75.0 %); no significant differences were found in CUC and OC. The risk of death from CFRS was the same for TTS of ≤2 months in breast cancer and ≤12 months in other CFRS. Conclusion. Clinical practice shows that the time before the start of special treatment in accordance to state guarantees may be insufficient. early treatment initiation is often possible in the early stages of CFRS. The time to treatment start of < 8 weeks after morphological verification does not worsen survival. The identification of individual groups of patients who need earlier treatment is warranted.

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