Factors associated with cancer treatment delay: a protocol for a systematic review and meta-analysis

Kristin E. Morrill, Rogelio Robles-Morales, Melissa Lopez-Pentecost, Raigam J. Martínez Portilla, Ahlam A. Saleh, Meghan B. Skiba, Taylor S. Riall, Jessica D. Austin, Rachel Hirschey, Elizabeth T. Jacobs, Lena Spotleson, Timothy P. Hanna

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations


Introduction Treatment delays are significantly associated with increased mortality risk among adult cancer patients; however, factors associated with these delays have not been robustly evaluated. This review and meta-analysis will evaluate factors associated with treatment delays among patients with five common cancers. Methods and analysis Scientific databases including Ovid MEDLINE, Elsevier Embase, EBSCOhost CINAHL Plus Full Text, Elsevier Scopus and ProQuest Dissertations and Theses Global will be searched to identify relevant articles published between January 2000 and October 2021. Research articles published in the USA evaluating factors associated with treatment delay among breast, lung, prostate, cervical or colorectal adult cancer patients will be included. The primary outcome of the meta-analysis will be the pooled adjusted and unadjusted odds of treatment delay for patient, disease, provider and system-level factors defined according to specified time intervals. The secondary outcomes will be mean or median treatment delay for each cancer site according to first treatment and the influence of factors on the pooled mean treatment delay for each cancer site (via meta-regression analyses). Results from qualitative and mixed-methods studies will be narratively synthesised. Three reviewers will independently screen records generated from the search and two reviewers will independently extract data following a consensus agreement. Statistical heterogeneity will be assessed with a standard I 2 test and funnel plots will be conducted to evaluate publication bias. Risk of bias will be assessed independently by two authors using validated tools according to the article's study design. Ethics and dissemination Formal ethical approval is not required because the work is being carried out on publicly accessible studies. The findings of this review will be disseminated through a peer-reviewed scientific journal, academic conferences, social media, and key stakeholders. PROSPERO registration number CRD42021293131.

Original languageEnglish (US)
Article numbere061121
JournalBMJ open
Issue number6
StatePublished - Jun 1 2022


  • adult oncology
  • adult surgery
  • chemotherapy
  • quality in health care
  • radiotherapy

ASJC Scopus subject areas

  • General Medicine


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