It's a paradox: in advanced pancreatic cancer wait time doesn’t matter

  • Kruger S & al.
  • J Cancer Res Clin Oncol
  • 23 Oct 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Time to treatment initiation (TTI) appears not to affect OS in advanced pancreatic cancer.

Why this matters

  • This is the first study of TTI and advanced pancreatic cancer outcomes to account for lead time bias and the waiting time paradox.

Study design

  • Analysis of records from a prospectively maintained database (n=297).
  • Funding: Else Kröner-Forschungskolleg: Cancer Immunotherapy.

Key results

  • To account for lead time bias, the researchers only included patients who outlived the cutoff points for TTI.
  • 66% of patients had a TTI >21 days, defined by the researchers as a treatment delay. The most common reasons were a referral to an external treatment center (25.9%) and an additional biopsy (20.8%).
  • There was no significant difference in OS between TTI above or below the median (TTI ≤29 vs TTI >29 days; HR, 1.12; P=.362), at the 75th percentile of 43 days (HR, 1.03; P=.856), or at the 90th percentile of 60 days (HR, 1.04; P=.861).
  • The researchers accounted for the waiting time paradox, which can lead to reporting of improved survival with greater TTI when more severe cases are treated sooner: they found no correlation between TTI with carbohydrate antigen 19-9 levels (P=.17), which are the marker of severity.

Limitations

  • Retrospective study.