Has Growth in Patient Volumes Contributed to Cancer Treatment Delays?

For patients already enduring the stress of a cancer diagnosis, delays in treatment exacerbate distress and can worsen outcomes. With increasing demand for cancer care services in the United States, there are concerns regarding possible treatment delays, particularly in hospitals where increased demand is not matched by increased capacity. The past decade has seen a movement toward healthcare consolidation, and this may have contributed to even greater patient volume growth at National Cancer Institute (NCI)-designated cancer centers and academic hospitals, which therefore might be most vulnerable to resultant treatment delays.

In this first analysis to investigate whether patient volume growth is associated with cancer treatment delays, PC3I Innovation Fellow Zachary Frosch, MD, MSHP found that while time to treatment initiation (TTI) is increasing across hospital types over time, this did not result in clinically meaningful delays. Analyzing data from 2007 to 2016, Dr. Frosch and co-investigators evaluated patient volume growth rates by hospital type as well as the relationship between each hospital’s patient growth and time to treatment initiation (TTI). The dataset consisted of adult patients undergoing their first course of treatment within one year of diagnosis for the ten most commonly diagnosed cancers in the United States: breast, lung, prostate, colorectal, melanoma, bladder, non-Hodgkin lymphoma (NHL), renal, uterine or pancreatic.

The findings demonstrated that patient volume growth was higher at NCI and academic centers than at community hospitals for nine of the ten types of cancer included in the study. That being said, there were no clinically meaningful treatment delays associated with to receipt of care at hospitals with higher patient volume growth rates. While this is reassuring, increasing TTI across hospital types emphasizes the need for continued efforts to ensure timely treatment for patients with cancer.

The study, “Trends in patient volume growth by hospital type and their association with timely cancer treatment,” appeared in JAMA Network Open on July 9, 2021. The authors were: PC3I Fellow Zachary Frosch, MD, MSHP; Nicholas Illenberger, MS; Nandita Mitra, PhD; Daniel J Boffa, MD; Matthew A Facktor, MD; Heidi Nelson, MD; Bryan E Palis, MA; PC3I Faculty Justin E Bekelman, MD; PC3I Advisory Group Member Lawrence N Shulman, MD; and PC3I Faculty Samuel U Takvorian, MD, MSHP.