Cancer Surgery Waiting Times Rising: What Oncology Nurses Need to Know

A comprehensive cohort study published in JAMA Surgery has revealed a steady, significant increase in waiting times for definitive cancer surgery in the United States over the past decade. Evaluating over 2.7 million patients diagnosed with clinical stage I through III solid malignancies from 2012 to 2023, the national analysis found that median times from diagnosis to first-course therapy grew across all six cancer types examined.

Led by Sara Sakowitz, MD, MPH, and senior author Timothy R. Donahue, MD, of the David Geffen School of Medicine at UCLA, the study highlights critical systemic bottlenecks and widening disparities in access. For oncology nurses, who are at the frontline of patient navigation, coordination, and psychosocial support, these findings underscore an urgent need for proactive clinical intervention.

Worsening Delays Across Malignancies

Using the National Cancer Database (NCDB), the researchers assessed waiting times—defined as the interval between diagnosis and the initiation of first-course therapy (either up-front surgical resection or neoadjuvant therapy preceding surgery). The final cohort of 2,731,059 patients had a mean age of 63.5 years, and 85% were female.

Between 2012–2015 and 2022–2023, median waiting times rose significantly across all six evaluated malignancies:

• Breast cancer: rose from 34 to 45 days (interquartile range [IQR], 32–64
• Colon cancer: rose from 20 to 31 days (IQR, 15–49)
• Lung cancer: rose from 41 to 53 days (IQR, 35–77)
• Pancreatic cancer: rose from 23 to 32 days (IQR, 22–44)
• Gastric cancer: rose from 35 to 49 days (IQR, 33–70)
• Esophageal cancer: rose from 38 to 48 days (IQR, 35–66)

These rising delays occurred regardless of whether patients underwent up-front resection or received neoadjuvant treatment first. This indicates that the worsening delays are not merely a result of more complex, multimodal neoadjuvant therapy but are driven by broader, systemic capacity constraints.

Systemic Bottlenecks: Centralization and Technology

The authors point to a tension within modern oncology: centralizing complex cancer care. While regionalization and referral to high-volume hospitals (HVHs) and academic medical centers improve postoperative survival, they create bottlenecks when referral demand exceeds surgical capacity.

Waiting times were longer at academic institutions than community hospitals. For example, in 2022–2023, the shortest median waiting times for lung, pancreatic, and esophageal cancers occurred at integrated network programs. Referred patients experienced longer wait times, particularly those referred to HVHs.

The study also identified a technological bottleneck: robotic surgery. For nonbreast malignancies, robotic operations were independently linked to prolonged (≥30 days) and extreme (≥60 days) delays. This likely reflects scheduling bottlenecks from high technology demand.

Sociodemographic Disparities and Survival Impact

The study revealed that the burden of surgical delays is not distributed equally. After comprehensive risk adjustment, several sociodemographic factors were strongly predictive of prolonged and extreme delays. Medicaid insurance, uninsured status, lower household income, and Black race were all independently associated with longer waiting times. Black patients and those on Medicaid faced significantly higher odds of both prolonged and extreme delays across nearly all cancer subtypes.

For patients, surgical delays are not benign. A growing body of literature has linked prolonged surgical delays with inferior survival. Specifically, delayed surgical resection is associated with a 20% to 30% increased risk of mortality in lung cancer, a 10% to 15% increased risk in breast cancer, a 15% increased risk in gastric cancer, and a nearly twofold mortality risk in locally advanced esophageal cancer. Beyond survival, waiting for cancer treatment causes profound distress, anxiety, and a severely impaired quality of life.

Key Implications for Oncology Nurses

Oncology nurses are uniquely positioned to help mitigate these delays and support patients navigating the system:

• Targeted Navigation: Nurse navigators must prioritize support for Black, low-income, uninsured, or Medicaid-insured patients to streamline insurance authorization and intake.
• Leveraging Integrated Networks: Nurses should leverage integrated network pathways where possible, as these programs coordinate care more efficiently than centralized academic centers.
• Calibrating Referrals: For uncomplicated cases (such as straightforward breast-conserving surgery or standard colectomies), referral to a local community or integrated network hospital rather than a congested academic center may prevent unnecessary delays.
• Psychosocial Support: Nurses must actively monitor and manage the psychological distress and anxiety experienced by patients during prolonged waiting periods.

Reference

1. Sakowitz S, Yamashita M, Donahue TR. National trends and predictors of waiting times for cancer surgery in the US. JAMA Surg. Published online August 12, 2026. doi:10.1001/jamasurg.2026.3212