E458: The Impact of Therapeutic Treatment Delay on Survival Outcomes in Gastric Cancer

Gastric cancer in Western countries is often associated with advanced stage at presentation and poor overall prognosis. Early treatment is a fundamental principle of oncologic care; however, the influence of therapeutic treatment delay (TTD) on oncologic outcomes in gastric cancer is unclear.

Methods:

This was a population-based, retrospective cohort study of all patients diagnosed and treated with gastric cancer between 2016 and 2021 in a provincial health region. We evaluated the relationship between TTD and oncologic outcomes. TTD was defined as >60 days from time of diagnosis to initiation of first treatment. A multivariate logistic regression model was done to identify risk factors for TTD. Kaplan-Meier curve estimation and log-rank testing was used for survival analysis.

Results:

A total of 331 patients were included. The median age at diagnosis was 71 years (IQR 61-79) and 61.3% were male.  44.3% (145/331) of index presentations were to the Emergency Department. Staging investigations included CT scan (97.9%), MRI (6.8%), PET (23.5%) and diagnostic laparoscopy (38%). The median number of specialists seen prior to treatment was 4 (IQR 3-5). The median time between diagnosis and treatment was 49 days (IQR 28-70). In total, 47.2% of patients (157/331) experienced TTD, with some patients (8.5%) waiting >90 days before initiation of first treatment. Age >= 75 years was a significant predictor of TTD (OR 1.6, 95% CI 1.01-2.56, p< 0.05). Patients experiencing a TTD had worse overall survival (31 vs 37 months, p=0.02).

Conclusions:

Many patients with gastric cancer experience TTD, which may negatively impact survival. Advanced age is a significantly risk factor for TTD.