Time to treatment initiation in primary extremity sarcomas: Determinants and oncological outcomes in a tertiary LMIC cancer center

Background

or purpose: Time to treatment initiation (TTI) has emerged as a key quality control metric in oncology, with early treatment initiation translating to improved survival in certain malignancies. However, data is lacking for primary extremity sarcomas (PES). Hence, this study aimed to quantify TTI, identify factors influencing TTI, and evaluate its effect on oncological outcomes in PES.

Methods

This study was a retrospective analysis of patients with PES who received curative-intent treatment between 2011 and 2020. Various demographic details, tumor characteristics, treatment, healthcare variables, and oncological outcomes were analysed.

Results

Median TTI for primary bone sarcoma (PBS) was 24 days, and for primary soft tissue sarcoma (PSTS) was 35 days. Univariate analysis of PBS, age >20 years (p < 0.001), low-grade tumors (p = 0.011), chondrosarcoma as histology (p < 0.001), and surgery as the first treatment (p < 0.001) modality were associated with a delayed TTI. On multivariate analysis, only age (p < 0.001) and histology (p = 0.002) retained significance. In PSTS, age >20 years (p = 0.018) and non-affordability (p = 0.019) were significant in both univariate and multivariate analyses. Differences in TTI (early vs late) did not translate to changes in oncological outcomes, with similar overall survival rates at both 3-year and 5-year follow-up, for both PBS (p = 0.719) and PSTS (p = 0.786).

Conclusion

TTI is multifactorial. Though early treatment initiation did not impact survival rates, this study introduces a structured framework for auditing institutional workflows to identify bottlenecks and facilitate system-level improvements in the delivery of multidisciplinary sarcoma care.