Treatment delays and new evidence

Dear BOPA members

We are delighted to share two studies that you may be interested in for your practices.  The studies outline the impact of treatment delays (i.e. Delays in between cycles of SACT) on survival.  Delays occur for several reasons these can be toxicity related, through patient choice or due to service constraints.

In our study of patients with early breast cancer we found that a delay of 7 days significantly increases all-cause mortality.

https://www.ejcancer.com/article/S0959-8049(24)00957-2/fulltext

What this means to my practice

• Toxicity management is really important and nationally there are still admissions with preventable toxicity for these patients i.e. vomiting. We can all play a key role in optimising supportive care and managing preventable delays.
• It is really important that we all standardise our protocols in terms of threshold values for neutrophils and platelets in conjunction with our medical teams.  See the results of a BOPA survey that was published in Cancer Medicine highlighting the variation in practice. https://onlinelibrary.wiley.com/doi/10.1002/cam4.4316
• Many services will assess bloods 4 days in advance of treatment and sometimes patients are  delayed when bloods are not adequate. Point of care blood testing should be considered where feasible.
• A 7-day delay should not be the standard for this group where dose intensity is clearly very important.

In our study of patients with advanced ovarian cancer we found that a delay of 7 days was not associated with mortality

https://academic.oup.com/oncolo/advance-article/doi/10.1093/oncolo/oyae201/7750798?searchresult=1

What this means to my practice

• Ensure that patients feel reassured when they are delayed from treatments due to toxicity that this should not affect their life span

Thank you

Pinkie Chambers and Chiara Creed

UCLH NHS Foundation Trust