Delayed in transit.

Just in time for another COVID-19 resurgence, this meta-analysis of 34 studies including over 1.2 million patients examined the survival impact of cancer treatment delays, defined as time from diagnosis to first surgical chemo or radiation treatment be it definitive, adjuvant or neoadjuvant. Cancer diagnoses included breast, colorectal, lung, cervical, head and neck, and bladder. Pooled hazard ratios were converted to denote increased risk of death for every 4- week delay. Overall, 4-week surgical delays resulted in 6-8% increases in the risk of death, while 4-week delays in definitive head and neck radiotherapy resulted in a 9% increase and in adjuvant chemo for colorectal cancer a 13% increase. As expected, delays in adjuvant radiation for breast cancer were not pronounced. Now is a good time to remember that a meta-analysis of biased studies yields bias, and there’s really no great way to control for whatever it was that caused treatment delays in the first place. TBL: This time around, delays in cancer treatment to minimize risk of COVID-19 exposure will likely be much less common—just ask your app. | Hanna, BMJ 2020

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