SRS306 - Time to treatment and outcomes in oesophagogastric cancer: a systematic review and meta analysis

Abstract Background Timely delivery of treatment is considered important in cancer care, as tumour progression and patient deconditioning may occur during the period between diagnosis and treatment. It is also a time associated with psychological distress for patients and families. However, the impact of time to initial treatment on outcomes in oesophagogastric (OG) cancer is poorly defined, with no universally accepted thresholds for acceptable waiting periods. Methods We conducted a systematic review in accordance with PRISMA guidelines (PROSPERO ID CRD1150696). MEDLINE, Embase and the Cochrane Library were searched (January 2000–August 2025) for empirical studies evaluating associations between time to treatment and outcomes in adults with histologically confirmed epithelial OG cancer treated with curative intent. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I. The primary outcome was overall survival. Results From 1628 records screened, 20 studies were eligible. Definitions of ‘time to treatment’ varied considerably. For diagnosis-to-treatment intervals, most studies did not demonstrate a consistent survival detriment, though methodological heterogeneity limited comparability. No studies examined time to endoscopic resection, despite its increasing use in early OG cancer. Overall certainty of evidence was low to moderate. Many studies were constrained by the ‘waiting time paradox’ and assumed a constant effect of delay on survival, without accounting for time-varying effects. Conclusions Current evidence on time to treatment in OG cancer is limited and inconsistent. Future research should apply more robust methodologies and evaluate treatment-specific intervals to better inform clinical practice and policy.