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Journal of Cancer Research and Clinical Oncology

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01-02-2020 | Pancreatic Cancer | Original Article – Clinical Oncology

Prolonged time to treatment initiation in advanced pancreatic cancer patients has no major effect on treatment outcome: a retrospective cohort study controlled for lead time bias and waiting time paradox

Authors: Stephan Kruger, Karoline Schirle, Michael Haas, Alexander Crispin, Jörg Schirra, Julia Mayerle, Jan G. D’Haese, Wolfgang G. Kunz, Jens Ricke, Steffen Ormanns, Thomas Kirchner, Sebastian Kobold, Matthias Ilmer, Leonie Gebauer, Christoph B. Westphalen, Michael von Bergwelt-Baildon, Jens Werner, Volker Heinemann, Stefan Boeck

Published in: Journal of Cancer Research and Clinical Oncology | Issue 2/2020

Abstract

Purpose

A prolonged time to treatment initiation (TTI) correlates with an adverse prognosis in different cancer types including resectable pancreatic cancer (PC). Only limited evidence on the correlation between TTI and prognosis in advanced PC exists.

Methods

Consecutive PC patients (n = 368) who were diagnosed or treated at our high-volume comprehensive cancer center were included in a prospectively maintained database. We retrospectively analyzed time from first imaging showing advanced PC to initiation of palliative first-line chemotherapy. Lead time bias and waiting time paradox were addressed by landmark analysis and correlation of tumor burden with TTI.

Results

Two hundred and ninety-seven patients met the pre-specified in- and exclusion criteria of our study. Median TTI was 29 days (range: 1–124 days). Most common reasons for prolonged TTI (> 21 days) were referral from an external treatment center (39%) and a second biopsy (31%). A TTI above the median-, 75th or 90th percentile (43 or 60 days, respectively) had no impact on overall survival. Furthermore, no correlation between levels of carbohydrate antigen 19-9 (CA 19-9) at time of treatment initiation and TTI was observed.

Conclusion

While a timely work-up of advanced PC patients remains important, delays in treatment initiation due to repeated biopsies, inclusion in a clinical study or transfer to a specialized cancer center appear to be justified in light of the absence of a strong adverse effect of prolonged TTI on prognosis in advanced PC patients.

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Title: Prolonged time to treatment initiation in advanced pancreatic cancer patients has no major effect on treatment outcome: a retrospective cohort study controlled for lead time bias and waiting time paradox
Authors: Stephan Kruger
Karoline Schirle
Michael Haas
Alexander Crispin
Jörg Schirra
Julia Mayerle
Jan G. D’Haese
Wolfgang G. Kunz
Jens Ricke
Steffen Ormanns
Thomas Kirchner
Sebastian Kobold
Matthias Ilmer
Leonie Gebauer
Christoph B. Westphalen
Michael von Bergwelt-Baildon
Jens Werner
Volker Heinemann
Stefan Boeck
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatic Cancer
Pancreatic Cancer
Cytostatic Therapy
Published in: Journal of Cancer Research and Clinical Oncology / Issue 2/2020
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-019-03061-4

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Prolonged time to treatment initiation in advanced pancreatic cancer patients has no major effect on treatment outcome: a retrospective cohort study controlled for lead time bias and waiting time paradox

Abstract

Purpose

Methods

Results

Conclusion

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