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The high burden of COVID-19 in hospitals puts increased pressure on oncological care worldwide, forces prioritization of healthcare resources and causes delays in cancer treatment pathways. Prior research underlined the importance of timely oncological care, as longer waiting times from diagnosis to treatment could result in poorer outcomes for some common malignancies. The aim of this study was to determine the impact of waiting time from diagnosis to treatment on overall survival in patients with cervical cancer treated with surgery or radiotherapy with curative intent.

Patients from a nationwide population-based cohort with newly diagnosed cervical cancer between 2010 and 2019 were studied. Patients who underwent surgery or radiotherapy with curative intent were selected. Waiting time was defined as the time interval between first pathologic confirmation of carcinoma and the day of first treatment. Waiting time was modeled as continuous (i.e. linear per week), dichotomized (i.e. ≤8 versus >8 weeks), and polynomial (i.e. restricted cubic splines). The association between waiting time and overall survival was examined using Cox proportional hazard analyses.

Among 6,895 patients with newly diagnosed cervical cancer, 2,831 patients treated with primary surgery and 1,898 patients who received primary radiotherapy were included. Waiting time to surgery was 8.5 (±4.2) weeks on average and >8 weeks in 1,287 patients (45%). Waiting to radiotherapy was 7.7 (±2.9) weeks on average and >8 weeks in 681 patients (36%). In the surgery group, a longer waiting time was associated with younger age, fertility treatment, adenocarcinoma histology, poor differentiation grade, LVSI, higher T- and N-stage, and previous conization or portio amputation. Adjusted for confounders, waiting time to surgery was not significantly associated with overall survival (continuous HR 0.99 [95%CI: 0.95-1.02], dichotomized HR 0.93 [0.69-1.26], polynomial HR in Figure 1). In the radiotherapy group, a longer waiting time was associated with higher BMI, higher number of co-morbidities, and lower T-stage. Chemotherapy was administered concurrently with radiotherapy in 1,276 patients (67.2%) and was not associated with a longer waiting time. Adjusted for confounders, a longer waiting time to radiotherapy was not significantly associated with poorer overall survival (continuous HR 0.97 [95%CI: 0.93-1.00], dichotomized HR 0.91 [0.76-1.09], polynomial HR in Figure 2).

This large population-based cohort study demonstrates that a longer waiting time from diagnosis to treatment (of up to 12 weeks) in patients with cervical cancer treated with curatively intended surgery or radiotherapy does not negatively impact overall survival. These results could help inform and reassure patients regarding their waiting time, for example when time is needed for fertility preservation.