A new study of more than 2.7 million patients has found that across six different cancers, the time between diagnosis and the start of treatment has grown steadily over the past decade, by ten days or more, and with striking consistency. For a patient, that stretch of waiting is an excruciating one, shadowed by the fear that the disease is advancing while nothing yet is being done about it. As the study's senior author, a UCLA surgical oncologist, put it, across every cancer they studied, patients are waiting longer today than they were ten years ago.
The natural way to read that finding is as a system in decline: more overwhelmed, slower, worse at its job. Part of that reading is true. But the fuller picture is more complicated, and more useful, than a simple story of failure. The growing wait is really two very different things bundled together inside one number, and pulling them apart matters a great deal, both for understanding the trend and for fixing it.
What the study found
The researchers drew on the National Cancer Database, a national repository maintained by the American College of Surgeons, covering the years 2012 through 2023. They focused on stage 1 to 3 cancers that were considered eligible for surgery at the time of diagnosis, across six cancer types, and measured the interval between diagnosis and the first treatment of any kind, whether surgery, radiation, chemotherapy, or another therapy.
The result was consistent across the board: patients in 2023 were waiting meaningfully longer to begin treatment than patients a decade earlier. The study points to several possible explanations, the growing complexity of cancer care, shortages in the workforce, and insurance pre-authorization, but it is careful about causation. It documents the trend clearly. The reasons behind it, it can only point toward, and those reasons are where the real story lies.
Some of the wait is the price of better medicine
Here is what complicates the story of straightforward decline. A decade ago, a cancer diagnosis often moved fairly quickly to a fairly standard treatment. Today, before treatment begins, there is frequently a far more elaborate process. The tumor may be profiled at the molecular and genetic level to identify what is driving it. A multidisciplinary tumor board may convene to weigh options. Staging has grown more precise, and clinicians increasingly evaluate whether a targeted therapy, or a course of treatment before surgery rather than after, would serve the patient better, and whether a clinical trial might fit.
All of that makes the eventual treatment more personalized and, often, more effective. It is genuinely better medicine than the one-size-fits-most approach it replaced. But it takes time. So a portion of the growing wait is simply the time cost of precision, the difference between diagnosing and treating quickly with a standard plan, and diagnosing, profiling, deliberating, and then treating precisely with a tailored one. The second is better care, and it is slower care, and on a stopwatch "more careful" and "more delayed" are indistinguishable. That is the part of this trend that a story of pure failure misses.
But some of the wait buys nothing at all
It would be a serious mistake, though, to let that reframe absorb the whole problem, because not all of the delay is that kind. The other cited factors are pure friction, waiting that adds no value whatsoever. Insurance pre-authorization, the requirement that an insurer approve a treatment before it can proceed, is a bureaucratic gate that postpones care without improving it in any way. Workforce shortages, too few oncologists and specialists, particularly outside major cities, delay treatment for reasons of sheer capacity rather than considered judgment.
This kind of waiting does not buy a more precise diagnosis or a better-matched therapy. It simply makes an already frightened patient wait longer. So the total delay the study measured is a mixture of two opposite things: time that purchases better treatment, and time that purchases nothing at all. On the calendar they are identical, each just another day before care begins. In value they are opposites, and no single number can tell them apart.
Why telling them apart is the whole point
That is precisely why the aggregate wait-time figure, taken on its own, cannot tell you whether this trend is good or bad. It is measuring two opposite phenomena at once. A lengthening wait is not self-evidently a failure, not if the added days are buying more effective, more personalized care. And it is not acceptable either, not if the added days are friction that helps no one. Read as a single signal, the number is genuinely ambiguous: part of it may mean care is getting more careful, and part of it may mean the system is getting more clogged, and the two are moving in the same direction on the chart while pointing in opposite directions on the merits.
Which means the task this study points toward is not to drive the wait to zero. It is to decompose the wait, to identify and protect, even accelerate, the deliberation that produces better treatment, while identifying and eliminating the friction that produces only delay. Aiming to shrink the total number without distinguishing its parts would risk cutting the good deliberation along with the bad friction, and that would be its own kind of failure.
Even the "good" delay has a real cost
Still, it is important not to let the reframe drift into complacency, because even the justified portion of the wait is paid for by the patient, in the hardest currency. Waiting is excruciating no matter the reason for it, and for some cancers and some patients a delay can matter clinically, a window narrowing, a disease advancing, in ways that are not merely a question of anxiety. So "it is the price of precision" is an explanation, and it should never become an excuse.
The goal should not be to accept slower care as the unavoidable cost of better care, as if the two must always travel together. It should be to obtain the precision without the wait: faster molecular testing, tumor boards that convene in days rather than weeks, the various steps of a workup run in parallel instead of one after another. Better medicine does not have to mean slower medicine, and the patient lying awake waiting for a plan is reason enough to keep trying to make the good part faster, not just to defend it as worthwhile.
A measured word for patients
For anyone living through this, a plain word is owed, meant neither to alarm nor to dismiss. A longer average wait measured across a whole population does not mean that any individual patient's care is being mishandled. A great deal of the pre-treatment workup that adds days is the medicine functioning exactly as it should, tailoring the plan to the specific disease in front of it. Some of it may indeed be avoidable friction. The person best positioned to tell which is which, in any particular case, is the patient's own care team, who can explain whether a given step is necessary deliberation or removable delay, and whether anything can be safely sped up.
The study is a signal to the system, not a verdict on any one person's treatment. Read the finding that cancer patients wait longer than they did a decade ago for what it is, real, consistent, and worth taking seriously, but understand that the number is a composite of two opposite things. There is the extra time that buys a more precise, more personalized, often better treatment, and there is the extra time that buys nothing but worry. The failure would be to read the rising wait as a single story, either to wave it away as the acceptable price of progress or to treat every added day as evidence of collapse. The honest response is harder and more worthwhile: to pull the two apart, to protect and hasten the deliberation that helps, and to go after the friction that does not, so that the sophisticated, tailored medicine modern oncology has learned to practice can reach patients as quickly as their fear demands. The wait grew for more than one reason, and the reasons are not equal. Sorting them out is the work.
Primary sources
- STAT, in reporting by Angus Chen, for the new study finding that, across six cancers, the time between diagnosis and first treatment grew steadily over roughly a decade, by ten days or more, the analysis of more than 2.7 million patients using the National Cancer Database, maintained by the American College of Surgeons, from 2012 to 2023, restricted to stage 1 to 3 cancers eligible for surgery at diagnosis and measuring time to any first treatment, surgery, radiation, chemotherapy, or other therapies, and senior author Tim Donahue's observation about the consistency of the trend across every cancer studied.
- The possible contributing factors cited in the study, namely the growing complexity of care, workforce shortages, and insurance pre-authorization.
- General, well-established background on contemporary oncology practice, including molecular and genetic tumor profiling, multidisciplinary tumor boards, precision and neoadjuvant treatment approaches, the burden of insurance pre-authorization, and oncology workforce shortages.