Why isn't there always a level of urgency to start chemo asap?

[Medic_90x]

It seems like there's usually a fair delay before chemo is eventually started. Doesn't this allow for greater tumor growth and advancement of the cancer? And why the delays from diagnosis to initiation of treatment for someone who's otherwise been healthy and at a good body weight etc.

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[unleash500]

Let me ask you this , why should there be?

Most cancers are not like a raging acute infection or an MI where early treatment is necessary. Cancer can come about insidiously/slowly and thus forgoing treatment by a few days isn’t going to make a difference. There are a lot of different types of cancer that grow and advance at different rates. Furthermore, chemotherapy does not magically get rid of the cancer also at least for solid tumors. Many of these treatments take many cycles to see a response. Different time scales here.

 

[HariboGoldbears]

In your experience as an oncologist what is a reasonable time to initiation of treatment from initial presentation and from the time the patient hears the C word?

 

[gutonc]

In your experience as an oncologist what is a reasonable time to initiation of treatment from initial presentation and from the time the patient hears the C word?

For oncologic or psychologic reasons?

For the oncologic reasons:
Even an AML patient who is otherwise "healthy" can wait a couple of weeks before initiating treatment. Same is true for most other cancers that aren't threatening end-organ damage.

And keep in mind that the cancers that will respond rapidly to treatment (acute leukemias, high-grade lymphomas and small cell cancer) are pretty rare. Your metastatic colon, breast, lung and prostate patients don't typically have a clinical response (which is what matters, not whether their tumor marker goes down or their CT looks better) for 6-12 weeks after starting treatment. So if you give chemo to a sick (ECOG 3+) patient with one of these cancers because OMFGWTFLOLZ!!!! it's CANCER, they're more likely to die in the ICU than they are to get better.

For psychological reasons, obviously, last week is the right answer.

By the time most cancers are diagnosed (especially late stage cancers), they have been present for years. Another week or so to start treatment will not make a difference.

 

[CatFactorial]

It seems like there's usually a fair delay before chemo is eventually started. Doesn't this allow for greater tumor growth and advancement of the cancer? And why the delays from diagnosis to initiation of treatment for someone who's otherwise been healthy and at a good body weight etc.

Also important to do due diligence in pre-treatment work up to minimize short term and long term toxicity

 

[gutonc]

Also important to do due diligence in pre-treatment work up to minimize short term and long term toxicity

This can't be overstated and is often not considered much/at all by many referring physicians (and too many oncologists).

Just because we can do something, doesn't always mean that we should.