Cancer surgery waits climb, longest at academic centers

Clinical takeaway: Match the referral to the complexity of the operation. High-volume and academic programs remain the right destination for technically demanding cases, but more routine cases may start treatment sooner closer to home. 

The timeline between a cancer diagnosis and the first real treatment is mostly invisible to a clinician looking at a chart. It shows up as a biopsy result, then a referral, then a call from scheduling, then a consultation date. But for the patient, it is a painful stretch of time spent knowing something awful is growing inside them--and nothing is being done about it yet. 

That interval of time to therapy has quietly stretched. Concentrating complex cancer surgery at high-volume programs was supposed to buy patients access to more innovative treatment and better infrastructure, and the tradeoff was framed as longer travel times. But capacity turned out to be another major cost. A retrospective cohort study of more than 2.7 million adults treated for six major cancers from 2012 through 2023 tracked how long that wait has become and where it lands the hardest. 

Comparing 2012-2015 with 2022-2023, median time from diagnosis to first-course therapy rose across all six cancers. Breast cancer wait time rose to 45 days from 34, colon to 31 from 20, lung to 53 from 41, pancreas to 32 from 23, gastric to 49 from 35, and esophageal to 48 from 38.  

The share of patients waiting 30 days or more climbed to 75% from 56% over the same period, and extreme waits of 60 days or more roughly doubled in most cancers. Half of patients were diagnosed at one institution and treated at another, and 80% of those went to a high-volume hospital. Referred patients waited longer than non-referred patients for every cancer examined, and those sent to high-volume centers waited longest of any group in every period.  

Academic programs ran longer than community hospitals across all six cancers even after adjustment for case mix and clustering. At Commission on Cancer integrated network programs, which distribute care across affiliated hospitals, wait times ran shorter than academic centers for several cancers. Robotic operations tracked with longer waits for all five non-breast cancers, which the authors attribute to scheduling constraints. 

Medicaid coverage was tied to prolonged waits for five of six cancers and lowest-quartile income for all six, and Black patients faced higher odds of extreme delay across every cancer subtype compared with white patients. Greater travel distance, higher comorbidity burden, and receiving care in the US West tracked with longer waits as well. 

Researchers used the National Cancer Database (NCDB), the largest US oncology registry and one that captures roughly 75% of cancer cases nationally, identifying adults with nonmetastatic stage I to III breast, colon, lung, pancreatic, gastric, or esophageal cancer who underwent curative-intent resection from 2012 to 2023. Waiting time ran from diagnosis to first-course therapy, meaning up-front surgery or the start of neoadjuvant treatment.  

The high volume, improved outcome case for sending patients to expert centers has not changed. What has changed is the price of admission, measured in patient days spent rather than just miles driven. For a technically demanding resection that tradeoff may be worth it. But for a lumpectomy or a straightforward colectomy, the same routing may offer nothing a nearby program cannot deliver. 

"The modern oncology system has optimized for specialization but not necessarily for timeliness. As cancer care continues to regionalize, timely access may become as important to health care quality as specialized expertise itself," write Lia Delaney, MD, MS, and Sherry Wren, MD, of Stanford University School of Medicine, in an invited commentary. 

Source: Sakowitz S, et al. (2026 Aug 12) JAMA Surg. National Trends and Predictors of Waiting Times for Cancer Surgery in the US