National Trends and Predictors of Waiting Times for Cancer Surgery in the US.

IMPORTANCE: As cancer care becomes increasingly complex, patients may experience prolonged delays between diagnosis and definitive surgical management. While consolidation and expansion of health systems, along with centralization of care, may further amplify these delays, a comprehensive assessment of contemporary waiting times within cancer surgery care pathways in the US is lacking. OBJECTIVE: To evaluate national trends and predictors of delays from diagnosis to initiation of first-course therapy among patients ultimately undergoing cancer surgery. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included patients with nonmetastatic, clinical stage I through III breast, colon, lung, pancreatic, gastric, or esophageal cancer in the National Cancer Database from January 2012 to December 2023 who underwent definitive surgical resection. Waiting time from diagnosis to first-course therapy, defined as up-front surgery or neoadjuvant therapy preceding surgery, was assessed. Data were analyzed from August 2025 to June 2026. MAIN OUTCOMES AND MEASURES: The primary outcome was the waiting time from diagnosis to first-course therapy. Secondary outcomes included factors associated with prolonged (≥30 days) or extreme (≥60 days) delays. RESULTS: A total of 2 731 059 patients were identified. Mean (SD) patient age was 63.5 (12.8) years, and 2 325 110 patients (85%) were female. From 2012 to 2023, median (IQR) time from diagnosis to first-course therapy increased across all malignancies (breast: 34 days [22-50] in 2012-2015 to 45 days [32-64] in 2022-2023; colon: 20 days [7-34] to 31 days [15-49]; lung: 41 days [27-60] to 53 days [35-77]; pancreas: 23 days [14-35] to 32 days [22-44]; gastric: 35 days [21-51] to 49 days [33-70]; and esophageal: 38 days [27-54] to 48 days [35-66]; P value for trend <.001 for all) and among both patients undergoing up-front surgery and those receiving neoadjuvant therapy prior to surgery. Delays were more pronounced at academic compared with community hospitals and among patients referred for care. Predictors of longer waiting time included Medicaid insurance (5 of 6 cancers), lowest-quartile income (6 of 6 cancers), Black race (5 of 6 cancers), increased travel distance (4 of 6 cancers), care in the West region (6 of 6 cancers), and treatment at academic institutions (6 of 6 cancers). Receipt of robotic operations was linked with longer waiting times for nonbreast malignancies (5 of 5 cancers). CONCLUSIONS AND RELEVANCE: Among patients undergoing cancer surgery, waiting times to initiation of first-course therapy have steadily increased since 2012, particularly at high-volume academic centers and among patients referred for definitive care. With continued consolidation and expansion of health systems, system-level strategies are urgently needed to monitor and mitigate delays in the delivery of surgical care for cancer.