Cancer Treatment Delay and Access Barriers in the United States: Fact Sheet

Key Message

In the United States, cancer treatment does not always start immediately after diagnosis. Large database studies show that time to treatment initiation often spans several weeks, and treatment delay has been associated with worse survival in multiple cancer settings.

TTI means time to treatment initiation. It generally refers to the time from cancer diagnosis to the start of the first cancer treatment.

Fact Table

No.	Topic	Key Fact	Source
1	Overall treatment timing	A U.S. National Cancer Database study of 5,615,193 patients across 30 major cancer types reported a median TTI of 26 days. Median TTI increased from 21 days in 2004 to 28 days in 2015.	JCO [1]
2	Hospital pathway timing	In 2016, adjusted mean TTI was 42 days at community hospitals, 44 days at academic hospitals, and 43 days at NCI-designated hospitals.	JAMA [2]
3	One-month treatment start	A SEER-based study of breast, lung, prostate, and colorectal cancer reported that 63.9% of patients started treatment within 1 month.	SEER [3]
4	Clinical risk of delay	A BMJ systematic review found that a 4-week delay in cancer treatment was associated with increased mortality risk across several surgical, systemic therapy, and radiotherapy indications.	BMJ [4]
5	Prior authorization and care access	In a 2025 AMA survey, 95% of physicians reported that prior authorization delays access to necessary care; 79% reported that some patients abandon treatment due to authorization challenges.	AMA [5]
6	Prior authorization and clinical impact	In the same AMA survey, 92% of physicians reported that prior authorization negatively affects clinical outcomes, and 26% reported that prior authorization had led to a serious adverse event.	AMA [5]
7	Radiation therapy authorization delay	In a 2024 ASTRO survey, 92% of radiation oncologists reported treatment delays due to prior authorization. Delays were reported to affect an average of 35% of patients, and 68% of physicians said the average delay was 5 days or longer.	ASTRO [6]

Source Notes

[1] JCO Oncology Practice. Time to Treatment Initiation for the 30 Most Prevalent Cancer Types.
Reported median TTI of 26 days across 30 major cancer types among 5,615,193 patients; median TTI increased from 21 days in 2004 to 28 days in 2015; stage I median TTI increased from 14 days to 28 days.
URL: https://ascopubs.org/doi/10.1200/OP.23.00614

[2] JAMA Network Open. Trends in Patient Volume by Hospital Type and the Association of These Trends With Time to Cancer Treatment Initiation.
Analyzed 4,218,577 patients at 1,351 hospitals from 2007 to 2016. Reported adjusted mean TTI in 2016 of 42 days at community hospitals, 44 days at academic hospitals, and 43 days at NCI-designated hospitals.
URL: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781734

[3] World Journal of Oncology. Time-to-Treatment Initiation and Its Effect on All-Cause Mortality: Insights From the Surveillance, Epidemiology, and End Results Database.
Reported that 63.9% of patients with breast, lung, prostate, and colorectal cancer initiated treatment within 1 month. The study also reported that longer TTI was independently associated with higher all-cause mortality after adjustment.
URL: https://wjon.elmerpub.com/wjon/article/view/2584

[4] The BMJ. Mortality due to cancer treatment delay: systematic review and meta-analysis.
Reported that a 4-week delay in cancer treatment was associated with increased mortality risk across several surgical, systemic therapy, and radiotherapy indications.
URL: https://www.bmj.com/content/371/bmj.m4087

[5] American Medical Association. 2025 AMA Prior Authorization Physician Survey / AMA survey: Prior authorization reform pledge falls short with physicians.
Reported physician survey findings including delayed care, treatment abandonment, negative clinical outcomes, serious adverse events, and administrative burden related to prior authorization.
URL: https://www.ama-assn.org/press-center/ama-press-releases/ama-survey-prior-authorization-reform-pledge-falls-short-physicians

[6] American Society for Radiation Oncology. How Prior Authorization Harms Cancer Care / 2024 Prior Authorization Survey.
Reported radiation oncologist survey findings on prior authorization-related delays, including treatment delay frequency and delay duration in radiation therapy.
URL: https://www.astro.org/getmedia/8d6c0ff0-cd7e-4f94-b77e-a8ef81b234e0/PriorAuthSurvey_2024ExecutiveSummary.pdf

Cancer Treatment Delay and Access Barriers in the United States: Fact Sheet

Cancer Treatment Delay and Access Barriers in the United States: Fact Sheet

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