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Economic and Financial Impacts of Cancer · Journal article
JAMA Surgery · August 12, 2026
Well-designed and adequately powered for the question it asks.
This large retrospective cohort study documents a consistent and statistically significant increase in waiting times from cancer diagnosis to initiation of first-course therapy across six major cancer types between 2012 and 2023, with median delays increasing by 11–22 days depending on malignancy type. Key risk factors for prolonged delays include Medicaid insurance, lowest-quartile income, Black race, greater travel distance, treatment in the West region, and care at academic institutions. The findings signal a system-level challenge in cancer care delivery that warrants targeted intervention.
Retrospective cohort study. Patients with nonmetastatic, clinical stage I–III breast, colon, lung, pancreatic, gastric, or esophageal cancer in the National Cancer Database from January 2012 to December 2023 who underwent definitive surgical resection.. Intervention: Definitive surgical resection (with or preceded by neoadjuvant therapy).. Compared with: Temporal comparisons across calendar periods (2012–2015 vs. 2022–2023) and between subgroups (academic vs. community hospitals, insurance status, race, income quartile, travel distance, robotic vs. non-robotic operations).. n = 2,731,059. United States (National Cancer Database); West region noted as a separate analytical variable..
Total of 2,731,059 patients with nonmetastatic, clinical stage I–III breast, colon, lung, pancreatic, gastric, or esophageal cancer identified from National Cancer Database, 2012–2023. Median waiting time from diagnosis to first-course therapy increased significantly across all six cancer types (P < 0.001 for trend): breast 34 days [IQR 22–50] in 2012–2015 to 45 days [32–64] in 2022–2023; colon 20 days [7–34] to 31 days [15–49]; lung 41 days [27–60] to 53 days [35–77]; pancreas 23 days [14–35] to 32 days [22–44]; gastric 35 days [21–51] to 49 days [33–70]; esophageal 38 days [27–54] to 48 days [35–66]. Medicaid insurance predicted longer waiting times in 5 of 6 cancers; lowest-quartile income and care in West region in all 6 cancers; Black race in 5 of 6 cancers.
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Clinicians and health system leaders should recognize that waiting times for cancer surgery have grown substantially over the past decade, particularly at academic centers and for socioeconomically disadvantaged and Black patients. These findings highlight the need for system-level interventions to prioritize timely access to surgical care and identify and mitigate barriers such as referral patterns, insurance status, and institutional factors.
Large retrospective cohort study with 2.7 million patients from a national database showing consistent, statistically significant trends in prolonged cancer surgery waiting times across six cancer types from 2012–2023, with identified risk factors and predictors.
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Quoted from the source exactly as published.
Clinicians and health system leaders should recognize that waiting times for cancer surgery have grown substantially over the past decade, particularly at academic centers and for socioeconomically disadvantaged and Black patients. These findings highlight the need for system-level interventions to prioritize timely access to surgical care and identify and mitigate barriers such as referral patterns, insurance status, and institutional factors.
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Importance As cancer care becomes increasingly complex, patients may experience prolonged delays between diagnosis and definitive surgical management. While consolidation and expansion of health systems, along with centralization of care, may further amplify these delays, a comprehensive assessment of contemporary waiting times within cancer surgery care pathways in the US is lacking. Objective To evaluate national trends and predictors of delays from diagnosis to initiation of first-course therapy among patients ultimately undergoing cancer surgery. Design, Setting, and Participants This retrospective cohort study included patients with nonmetastatic, clinical stage I through III breast, colon, lung, pancreatic, gastric, or esophageal cancer in the National Cancer Database from January 2012 to December 2023 who underwent definitive surgical resection. Waiting time from diagnosis to first-course therapy, defined as up-front surgery or neoadjuvant therapy preceding surgery, was assessed. Data were analyzed from August 2025 to June 2026. Main Outcomes and Measures The primary outcome was the waiting time from diagnosis to first-course therapy. Secondary outcomes included factors associated with prolonged (≥30 days) or extreme (≥60 days) delays. Results A total of 2 731 059 patients were identified. Mean (SD) patient age was 63.5 (12.8) years, and 2 325 110 patients (85%) were female. From 2012 to 2023, median (IQR) time from diagnosis to first-course therapy increased across all malignancies (breast: 34 days [22-50] in 2012-2015 to 45 days [32-64] in 2022-2023; colon: 20 days [7-34] to 31 days [15-49]; lung: 41 days [27-60] to 53 days [35-77]; pancreas: 23 days [14-35] to 32 days [22-44]; gastric: 35 days [21-51] to 49 days [33-70]; and esophageal: 38 days [27-54] to 48 days [35-66]; P value for trend lt;.001 for all) and among both patients undergoing up-front surgery and those receiving neoadjuvant therapy prior to surgery. Delays were more pronounced at academic compared with community hospitals and among patients referred for care. Predictors of longer waiting time included Medicaid insurance (5 of 6 cancers), lowest-quartile income (6 of 6 cancers), Black race (5 of 6 cancers), increased travel distance (4 of 6 cancers), care in the West region (6 of 6 cancers), and treatment at academic institutions (6 of 6 cancers). Receipt of robotic operations was linked with longer waiting times for nonbreast malignancies (5 of 5 cancers). Conclusions and Relevance Among patients undergoing cancer surgery, waiting times to initiation of first-course therapy have steadily increased since 2012, particularly at high-volume academic centers and among patients referred for definitive care. With continued consolidation and expansion of health systems, system-level strategies are urgently needed to monitor and mitigate delays in the delivery of surgical care for cancer.
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