Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

2009 • 78,446 citations

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.

2009 • 44,660 citations

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

2009 • 24,111 citations

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

2009 • 20,118 citations

High Performance of <sup>18</sup>F-Fluorodeoxyglucose Positron Emission Tomography and Contrast-Enhanced CT in a Rapid Outpatient Diagnostic Program for Patients with Suspected Lung Cancer

2013 • 3,981 citations

Assessing Bias in Studies of Prognostic Factors

2013 • 2,461 citations

Hepatogastroenterology

2012 • 2,302 citations

Systematic Reviews in Health Care : Meta-Analysis in Context

2000 • 2,282 citations

Systematic Reviews in Health Care

2001 • 1,637 citations

Systematic Reviews in Health Care. Meta-analysis in Context.

2002 • 1,441 citations

Evaluation of the Quality of Prognosis Studies in Systematic Reviews

2006 • 1,355 citations

Systematic reviews in health care: Systematic reviews of evaluations of prognostic variables

2001 • 759 citations

The Aarhus statement: improving design and reporting of studies on early cancer diagnosis

2012 • 651 citations

Overdiagnosis and Overtreatment in Cancer

2013 • 442 citations

Cutaneous Malignant Melanoma

2006 • 336 citations

Delays in the Diagnosis and Treatment of Lung Cancer

2005 • 273 citations

Delay in Surgical Treatment and Survival After Breast Cancer Diagnosis in Young Women by Race/Ethnicity

2013 • 251 citations

Effect of delays on prognosis in patients with non-small cell lung cancer.

2004 • 235 citations

Evidence of increasing mortality with longer diagnostic intervals for five common cancers: A cohort study in primary care

2013 • 226 citations

The size of the prize for earlier diagnosis of cancer in England

2009 • 217 citations

The National Awareness and Early Diagnosis Initiative in England: assembling the evidence

2009 • 215 citations

The role of primary care in early detection and follow-up of cancer

2013 • 202 citations

Effect on Survival of Longer Intervals Between Confirmed Diagnosis and Treatment Initiation Among Low-Income Women With Breast Cancer

2012 • 189 citations

Do diagnostic delays in cancer matter?

2009 • 185 citations

Delay in diagnosis and its effect on outcome in head and neck cancer

2005 • 183 citations

Timeliness of care in patients with lung cancer: a systematic review

2009 • 181 citations

The influence of hospital volume and surgical treatment delay on long-term survival after cancer surgery

2012 • 176 citations

Dermatologist Detection and Skin Self-examination Are Associated With Thinner Melanomas

2003 • 175 citations

IMPACT OF DELAY IN DIAGNOSIS ON CLINICAL STAGE OF TESTICULAR CANCER

1981 • 167 citations

Prognostic Factors in Erythrodermic Mycosis Fungoides and the Sézary Syndrome

1995 • 163 citations

Delay and survival in bladder cancer

2002 • 159 citations

Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits

2012 • 157 citations

Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care

2011 • 151 citations

Delays in diagnosis and bladder cancer mortality

2010 • 151 citations

Multiple myeloma: causes and consequences of delay in diagnosis

2007 • 150 citations

Delay in the Surgical Treatment of Bladder Cancer and Survival: Systematic Review of the Literature

2006 • 145 citations

Relationship of diagnostic and therapeutic delay with survival in colorectal cancer: A review

2007 • 142 citations

Diagnosis delay in Libyan female breast cancer

2012 • 140 citations

Delay in diagnosis of retinoblastoma: risk factors and treatment outcome

1999 • 134 citations

Impact of Delay on Diagnosis and Treatment of Primary Lung Cancer

2002 • 132 citations

The idiosyncratic relationship between diagnostic delay and stage of oral squamous cell carcinoma

2005 • 131 citations

Delay in the diagnosis of oral squamous cell carcinoma

1995 • 131 citations

PROGNOSTIC FACTORS IN ADVANCED NON-SEMINOMATOUS GERM-CELL TESTICULAR TUMOURS: RESULTS OF A MULTICENTRE STUDY

1985 • 129 citations

Extent and consequences of physician delay in the diagnosis of acral melanoma

1998 • 128 citations

Diagnostic interval and mortality in colorectal cancer: U-shaped association demonstrated for three different datasets

2012 • 122 citations

Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta‐analysis

2012 • 122 citations

The impact of delayed diagnosis of lung cancer on the stage at the time of operation

1997 • 121 citations

Delay in the Diagnosis and Treatment of Primary Bone Sarcoma of the Pelvis*

1999 • 119 citations

Melanoma and Tumor Thickness

1999 • 116 citations

Delayed Diagnosis in Children with Intracranial Germ Cell Tumors

2013 • 114 citations

The waiting time paradox: population based retrospective study of treatment delay and survival of women with endometrial cancer in Scotland

2002 • 113 citations

Factors related to patient delay in seeking medical attention for cutaneous malignant melanoma

1984 • 109 citations

Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia

2013 • 109 citations

The effects of symptoms and delay in seeking diagnosis on stage of disease at diagnosis among women with cancers of the ovary

1985 • 108 citations

Delayed Diagnosis of Retinoblastoma: Analysis of Degree, Cause, and Potential Consequences

2002 • 106 citations

The role of professional diagnostic delays in the prognosis of upper aerodigestive tract carcinoma

1998 • 105 citations

Delay in the diagnosis of cutaneous malignant melanoma. A prospective study in 250 patients

1991 • 105 citations

Impact of Wait Times on Survival for Women With Uterine Cancer

2013 • 104 citations

Oral and pharyngeal cancer: Analysis of patient delay at different tumor stages

2005 • 104 citations

Delays in Time to Treatment and Survival Impact in Breast Cancer

2010 • 101 citations

Age and lateness of referral as determinants of extra-ocular retinoblastoma

1989 • 101 citations

Delay in presentation of oral cancer: a multifactor analytical study.

2001 • 101 citations

A delay in radical nephroureterectomy can lead to upstaging

2009 • 98 citations

Nasopharyngeal carcinoma: presenting symptoms and duration before diagnosis.

1997 • 98 citations

Lack of association between diagnostic and therapeutic delay and stage of colorectal cancer

2008 • 96 citations

Stage, survival and delays in lung, colorectal, prostate and ovarian cancer: comparison between diagnostic routes

2007 • 94 citations

Diagnostic delay, quality of life and patient satisfaction among women diagnosed with endometrial or ovarian cancer: a nationwide Danish study

2011 • 91 citations

Presenting Symptoms, Treatment Delay and Survival in Bladder Cancer

1983 • 87 citations

Diagnostic delay and disease stage in head and neck cancer: A systematic review

2009 • 86 citations

Delay in Diagnosis and Survival in Testicular Cancer: Impact of Effective Therapy and Changes During 18 Years

1990 • 85 citations

Do diagnostic and treatment delays for colorectal cancer increase risk of death?

2013 • 84 citations

Treatment Delays in Non-small Cell Lung Cancer and Their Prognostic Implications

2011 • 83 citations

Does diagnostic delay result in decreased survival in paediatric brain tumours?

2008 • 83 citations

The symptom interval in children and adolescents with soft tissue sarcomas

2009 • 82 citations

The prognostic role of time to diagnosis and presenting symptoms in patients with pancreatic cancer

2013 • 82 citations

Impact of Diagnostic Delay in Testis Cancer: Results of a Large Population-Based Study

2007 • 80 citations

Timeliness of Care in Veterans With Non-small Cell Lung Cancer

2008 • 78 citations

The Relationship Between Melanoma Thickness and Time to Diagnosis in a Large Population-Based Study

2006 • 77 citations

Clinical presentation and waiting time targets do not affect prognosis in patients with pancreatic cancer

2010 • 76 citations

Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients

2002 • 76 citations

Delay of Surgery in Men With Low Risk Prostate Cancer

2011 • 76 citations

Duration of symptoms prior to diagnosis is related inversely to presenting disease stage in children with medulloblastoma

2001 • 74 citations

Time to diagnosis and breast cancer stage by race/ethnicity

2012 • 74 citations

Delayed treatment and continued growth of nonmelanoma skin cancer

2010 • 74 citations

Therapeutic Delays Lead to Worse Survival Among Patients With Hepatocellular Carcinoma

2013 • 73 citations

Survival with bladder cancer, evaluation of delay in treatment, type of surgeon, and modality of treatment.

1991 • 72 citations

Delay in Diagnostic Workup and Treatment of Esophageal Cancer

2009 • 72 citations

Delay in referral of oropharyngeal squamous cell carcinoma to secondary care correlates with a more advanced stage at presentation, and is associated with poorer survival

2006 • 72 citations

A systematic review of time to diagnosis in children and young adults with cancer

2013 • 71 citations

Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases

2006 • 71 citations

Time to Diagnosis of Ewing Tumors in Children and Adolescents Is Not Associated With Metastasis or Survival: A Prospective Multicenter Study of 436 Patients

2014 • 70 citations

Reducing Time to Diagnosis Does Not Improve Outcomes for Women With Symptomatic Ovarian Cancer: A Report From the Australian Ovarian Cancer Study Group

2011 • 67 citations

Acute lymphoblastic leukemia masquerading as juvenile rheumatoid arthritis: diagnostic pitfall and association with survival

2009 • 66 citations

Does prolonging the time to prostate cancer surgery impact long-term cancer control: a systematic review of the literature.

2006 • 65 citations

Diagnostic delay and complications for older adults with multiple myeloma

2009 • 65 citations

Does delay in diagnosing colorectal cancer in symptomatic patients affect tumor stage and survival? A population-based observational study

2010 • 64 citations

Does waiting time for radiotherapy affect local control of T1N0M0 glottic laryngeal carcinoma?

2000 • 63 citations

The symptom‐to‐diagnosis delay in soft tissue sarcoma influence the overall survival and the development of distant metastasis

2011 • 63 citations

Diagnostic delays in laryngeal carcinoma: Professional diagnostic delay is a strong independent predictor of survival

2002 • 63 citations

Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival

2014 • 62 citations

Gastric cancer in young patients with no alarm symptoms: focus on delay in diagnosis, stage of neoplasm and survival

2003 • 61 citations

The impact of patient and professional diagnostic delays on survival in pharyngeal cancer

2001 • 61 citations

Relative importance of diagnostic delays in different head and neck cancers

2008 • 61 citations

Patient and tumour factors associated with advanced carcinomas of the head and neck

2005 • 60 citations

Effect of Symptom-To-Treatment Interval on Prognosis in Lung Cancer

2007 • 60 citations

Head and neck carcinoma ? stage at presentation

1994 • 59 citations

Cancer survival and the duration of symptoms. An analysis of possible forms of the risk function

1994 • 57 citations

Determinants of patientʼs and doctorʼs delay in diagnosis and treatment of colorectal cancer

2011 • 54 citations

Laryngeal cancer patients: Analysis of patient delay at different tumor stages

2005 • 53 citations

Shorter Time to Diagnosis and Improved Stage at Presentation in Swiss Patients With Retinoblastoma Treated From 1963 to 2004

2006 • 52 citations

Upper tract urothelial carcinoma: Impact of time to surgery

2010 • 50 citations

Symptom-to-diagnosis interval and survival in cancers of the digestive tract.

2002 • 50 citations

Timeliness of lung cancer diagnosis and treatment in a rapid outpatient diagnostic program with combined 18FDG-PET and contrast enhanced CT scanning

2011 • 49 citations

High-Grade Osteosarcoma of the Extremity: Differences Between Localized and Metastatic Tumors at Presentation

2002 • 49 citations

Testicular Tumors: Presentation and Role of Diagnostic Delay

1987 • 48 citations

Diagnosis-to-Treatment Interval and Control of Locoregionally Advanced Head and Neck Cancer

2011 • 47 citations

Primary spinal cord tumors of childhood: effects of clinical presentation, radiographic features, and pathology on survival

2009 • 47 citations

Progression of Non–Small-Cell Lung Cancer During the Interval Before Stereotactic Body Radiotherapy

2010 • 45 citations

Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis

2011 • 43 citations

Does Length of Symptoms Before Diagnosis of Sarcoma Affect Patient Survival?

2007 • 43 citations

The 2‐week wait referral system does not improve 5‐year colorectal cancer survival

2011 • 42 citations

Relationships among delay of diagnosis, extent of disease, and survival in patients with abdominal carcinoid tumors

2004 • 42 citations

Diagnostic delay in pediatric solid tumors: A population based study on determinants and impact on outcomes

2011 • 41 citations

Long Time to Diagnosis of Medulloblastoma in Children Is Not Associated with Decreased Survival or with Worse Neurological Outcome

2012 • 40 citations

Relationship between delayed diagnosis and the degree of invasion and survival in lung cancer

2003 • 40 citations

Relationship between patients' early recognition of melanoma and depth of invasion

1982 • 39 citations

The Symptom-to-Treatment Delay and Stage at the Time of Treatment in Cancer of Esophagus

2008 • 39 citations

Delays in time to primary treatment after a diagnosis of breast cancer: Does it impact survival?

2012 • 38 citations

The “two-week wait” referral pathway allows prompt treatment but does not improve outcome for patients with oesophago-gastric cancer

2010 • 38 citations

The effect of diagnosis and treatment delay on prognostic factors and survival in endometrial carcinoma

1995 • 37 citations

Delays in the Diagnosis and Treatment of Primary Lung Cancer: Are Longer Delays Associated with Advanced Pathological Stage?

2008 • 37 citations

Prognostic factors in Sezary syndrome: a study of 28 patients

2003 • 37 citations

Proliferative activity and diagnostic delay in oral cancer

2010 • 37 citations

Delays in Primary Surgical Treatment Are Not Associated With Significant Tumor Size Progression in Breast Cancer Patients

2011 • 37 citations

Prognostic Significance of Presentation-to-Diagnosis Interval in Patients With Oropharyngeal Carcinoma

2004 • 36 citations

Effect of delays on survival in patients with lung cancer

2010 • 35 citations

Outcomes of Delays in Time to Treatment in Triple Negative Breast Cancer

2013 • 35 citations

Duration of symptoms: Impact on outcome of radiotherapy in glottic cancer patients

2005 • 34 citations

Factors associated with large cutaneous squamous cell carcinomas

2010 • 33 citations

Initial presentation and management of osteosarcoma, and its impact on disease outcome.

2009 • 33 citations

An Assessment of Factors Related to Tumor Thickness and Delay in Diagnosis of Melanoma in Southern Italy

2002 • 33 citations

Delayed Diagnosis of Leukemia and Association With Morbid-Mortality in Children in Pernambuco, Brazil

2012 • 32 citations

Testicular tumors: delay in diagnosis and influence on survival.

1984 • 32 citations

Actionable indicators for short and long term outcomes in rectal cancer

2010 • 31 citations

The Effect of Wait Times on Oncological Outcomes From Periampullary Adenocarcinomas

2013 • 31 citations

Influence of delay in diagnosis on prognosis in testicular teratoma

1989 • 31 citations

Time from Diagnosis to Surgical Treatment of Breast Cancer: Factors Influencing Delays in Initiating Treatment

2010 • 30 citations

Is a Treatment Delay in Radical Prostatectomy Safe in Individuals with Low-Risk Prostate Cancer?

2012 • 30 citations

Diagnostic delay and prognosis in invasive bladder cancer

2003 • 30 citations

Quality of life in newly diagnosed patients with lung cancer in a developing country: is it important?

2006 • 29 citations

Timeliness and quality of diagnostic care for medicare recipients with chronic lymphocytic leukemia

2010 • 28 citations

Factors associated with delays to medical assessment and diagnosis for patients with colorectal cancer.

2012 • 28 citations

Symptom presentation in invasive ovarian carcinoma by tumor histological type and grade in a multiethnic population: A case analysis

2010 • 27 citations

The Impact of Timeliness of Care on Survival in Non-small Cell Lung Cancer Patients

2012 • 27 citations

Pattern of Mortality in Childhood Acute Lymphoblastic Leukemia

2010 • 26 citations

Earlier diagnosis and treatment of symptomatic bowel cancer: can it be achieved and how much will it improve survival?

2009 • 26 citations

The association of waiting times from diagnosis to surgery with survival in women with localised breast cancer in England

2013 • 25 citations

Prognostic factors in stage IA–IIA cervical cancer patients treated surgically: does the waiting time to the operation affect survival?

2011 • 25 citations

Predictors of long‐term survival of lung cancer patients in a Norwegian community

2010 • 25 citations

Prognostic factors in advanced non-seminomatous germ-cell testicular tumours: results of a multicentre study. Report from the Medical Research Council Working Party on Testicular Tumours.

1985 • 24 citations

Impact of symptomatic interval on prognosis of patients with stage III testicular cancer

1983 • 24 citations

Prompt Orchiectomy Reduces Morbidty and Mortal from Testicular Carcinoma

1990 • 24 citations

The impact of the two‐week wait referral pathway on rectal cancer survival

2011 • 23 citations

Assessment of a rapid referral pathway for suspected colorectal cancer in Madrid

2011 • 23 citations

Retrospective analysis of the impact of symptom duration on prognosis in soft tissue sarcoma

2007 • 23 citations

Delayed diagnosis of endometrial cancer in Italy

1983 • 22 citations

Does delayed diagnosis or scrotal incision affect outcome for men with non‐seminomatous germ cell tumours?

1995 • 21 citations

Is timing to delivery of treatment a reliable measure of quality of care for patients with colorectal adenocarcinoma?

2013 • 21 citations

Delayed diagnosis and tumor stage in Ewing's sarcoma.

1999 • 21 citations

Nasopharyngeal carcinoma in Saudi Arabia: clinical presentation and diagnostic delay.

2010 • 20 citations

Intervals between Symptom Onset and Clinical Presentation in Cancer Patients

2009 • 20 citations

Trends in Time to Diagnosis of Colon Cancer and Impact on Clinical Outcomes

2012 • 20 citations

Is earlier referral and investigation of bowel cancer patients presenting with rectal bleeding associated with better survival?

2010 • 20 citations

Endometrial Adenocarcinoma—Lack of Correlation between Treatment Delay and Tumor Stage

1997 • 19 citations

Time to diagnosis of paediatric posterior fossa tumours: an 11-year West of Scotland experience 2000–2011

2012 • 19 citations

Analysis of survival versus patient and doctor delay of treatment in gastrointestinal cancer

1974 • 19 citations

Quality of reporting of studies evaluating time to diagnosis: a systematic review in paediatrics

2013 • 19 citations

Adenocarcinoma of the stomach in patients age 35 years and younger: No impact of early diagnosis on survival outcome

2002 • 18 citations

Delays in diagnosis and stage of disease in gynecologic cancer.

1981 • 18 citations

Impact on patient care time and tumor stage of a program for fast diagnosis and treatment of colorectal cancer

2011 • 18 citations

Diagnosis and treatment delay in gynecological malignancies. Does it affect outcome?

2000 • 18 citations

Effect of Patient-related Delay in Diagnosis on the Extent of Disease and Prognosis in Nasopharyngeal Carcinoma

2008 • 17 citations

Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years?

2011 • 17 citations

The effect of patient's delay and doctor's delay in patients with malignant germ cell tumours

1981 • 17 citations

Impact of diagnostic and treatment delay on survival in patients with renal pelvic and ureteral cancer

2006 • 16 citations

The impact of early or late diagnosis on patient survival in gastric cancer in Greece.

1992 • 15 citations

Impact of patient and professional diagnostic delays on the risk of recurrence in laryngeal carcinoma

2005 • 15 citations

Patient and Physician Treatment Delay in Patients with Stomach Cancer in Norway: Is It Important?

1991 • 15 citations

Weekend Delay in Initiation of Chemotherapy for Acute Lymphoblastic Leukemia

2012 • 15 citations

Prognostic assessment of various parameters in chronic myeloid leukemia

1986 • 15 citations

Factors influencing diagnosis of colorectal cancer: A hospital‐based survey in <scp>C</scp>hina

2012 • 15 citations

Diagnostic delays in vestibular schwannoma

2008 • 14 citations

Influence of delayed diagnosis on established prognostic factors in endometrial cancer.

1996 • 14 citations

The value of early diagnosis in the treatment of patients with testicular cancer.

1991 • 14 citations

Evolutive and prognostic aspects in gastric cancer. Analysis of 189 cases

1987 • 13 citations

The effect of diagnostic delay in patients with Hodgkin's lymphoma.

1995 • 12 citations

Undifferentiated carcinoma of nasopharyngeal type (UCNT): a Swiss single-institutional experience during 1990-2005

2010 • 12 citations

Testicular germ cell tumors

1980 • 12 citations

Research into practice: prompt diagnosis of cancer in primary care

2014 • 11 citations

Tumor size/symptom duration ratio as a prognostic factor in patients with high-grade soft tissue sarcomas

1988 • 11 citations

The effect of symptom duration in epithelial ovarian cancer on prognostic factors

2008 • 10 citations

Cutaneous malignant melanoma. Correlation between tumorcharacteristics and diagnostic delay in Norwegian patients

2000 • 10 citations

Ewing′s Sarcoma of the Upper Extremity: Presenting Symptoms, Diagnostic Delay and Outcome

2005 • 9 citations

The role of delay in stage III testicular tumours

1986 • 9 citations

Does Time to Definitive Treatment Matter in Patients with Ductal Carcinoma in Situ?

2013 • 9 citations

Urgency of referral and its impact on outcome in patients with colorectal cancer

2012 • 8 citations

Prognostic factors in metastatic nonseminomatous germ cell tumours.

1993 • 6 citations

Cancer of the larynx: correlation of clinical characteristics, site of origin, stage, histology and diagnostic delay.

1998 • 6 citations

The opportunity for improvement

2003 • 6 citations

Diagnostic delay and risk of relapse in patients with stage I nonseminomatous germ cell tumour followed on active surveillance

2000 • 5 citations

Time delay and its effect on survival in malaysian patients with non-small cell lung carcinoma.

2006 • 3 citations

Prognostic factors in follicular lymphoma: A single institution study

2008 • 3 citations

Clinical evolution of primary intramedullary tumors in adults

2012 • 2 citations