De invloed van uitstel van behandeling op de prognose bij patiënten met borstkanker

- The central issue of waiting lists is health loss that may result from treatment delay. As no randomised controlled trials exist, all studies on the relationship between delay and outcome are subject to bias, the extent of which depends on the mechanisms that cause delay. From published observational data, the deleterious effect of delay on prognosis was estimated to be nearly 2 in 5-year mortality per month of treatment delay in breast cancer. A modelling approach suggests a more limited delay-loss effect of around 1 per month of delay, equalling a loss of life expectancy of around 3 months. These figures support the belief that treatment of breast cancer should not be delayed further than a period of 3 weeks, striking a reasonable balance between therapeutic ‘surprise attack’ of the patient and unnecessary delay. In the presence of waiting lists, prioritisation of patient treatment should be guided by the aim to minimize health loss, based on the relationship between treatment delay and health loss. Such considerations are valid not only for breast cancer patients, but for all patients in whom delay may result in serious health loss.