Delayed radiotherapy could help

We return home late last night to see a hospital letter saying there is a 10 week delay for radiotherapy. Jan is disappointed, silent. She wants it all over so that she can "start her life again". Does this delay matter? Or has God got his perfect timing yet again?

In summary though this is a delay beyond NHS guidelines, government targets and what had been suggested several times by the hospital I believe it is for the best. How God over rules even our NHS! A long post, skip it if you just want summary, God continues to provide his best for us, and seems to know more about correct radiotherapy timing than our NHS.

I read the archives of our newspapers, and yes, it seems delay gives a 60% increase in the risk of Jan's early death. Thanks!

Here is just one of the many newspaper articles One newspaper says "write to your MP, complain etc." Jan is so upset she wants me to stop looking at the Internet for such data. Maybe I should, but I ignore her and after an hour or so of research till 00:45 I find I can re-assure her that all is OK, the delay does not matter, and we sleep peacefully....

In more detail the next morning, I go to the original serious article quoted by the newspapers. It is in the Journal of Oncology dated 2003,

It does indeed state the delay increases the risk of recurrence of cancer in the same area by 60%. Yet read more carefully it also states risk of the far more deadly distant metastases and death remain the same. I had earlier said I thought radiotherapy was the con trick of the century, this confirms my belief. Radiotherapy controls local recurrence, but makes little difference to long term survival, which would be the measure I more care about. Thinks, does this mean a recurrence of breast cancer hardly matters, if it recurs one has a mastectomy, so maybe that is why local recurrence makes no difference to long term survival? Maybe Jan would disagree!

But this is just one Canadian oncology paper which surveys 46 earlier papers and 15,782 patients. Its conclusion is "There was little evidence about the impact of delay in RT on the risk of metastases or the probability of long-term survival in any situation. Delay in the initiation of RT is associated with a decrease in LRR in breast cancer. Delays in starting RT should be as short as reasonably achievable."

I look deeper at the replies in later journals and find:

An excellent list of papers here

And this from Harvard which states that for certain radiation doses the optimum is SRI of 9 to 12 weeks. We know the hospital plan a high dose for Jan using a local boost which is why treatment has risen from the discussed 3 weeks to 4, though they have not told us the dose.
This second article concludes "I believe that the complex details of the interactions of the SRI with other parameters must be better understood to design optimal programs of surgery, chemotherapy, and radiotherapy for individual patient subgroups with different cancers." I would say this was one doctor calling another a "wally"!

A French reply states the first report "produced a result in contradiction with the conclusion of the largest study" In other words, "Dear sir, you are a wally". It does add "In recent years, delay in access to radiation therapy has been highly publicized. On compassionate grounds alone, treatment for cancer should always be initiated as early as possible after diagnosis. However, we believe that at least with respect to breast cancer, firm evidence concerning a specific delay that would have a detrimental effect on outcomes is still lacking, despite this ambitious work by Huang et al."

So we are now happy that the delay could well be for the best. Thank you Jesus. If the hospital letter had just said "Dear Jan, we believe that in your case radiotherapy is best commenced after 10 weeks" she would have gone to bed thrilled that all was being done for her best possible treatment.

I have not covered all papers, there are more worrying learned papers which say don't delay. Another says 8 weeks max. In contradiction another says wait at least 12 weeks for best results. So I am confused, or are even the doctors confused? Or is it that if radiotherapy makes as little real difference as I suspect it follows that timing makes little difference, hence the disagreement in these learned papers?

And a recent BMJ article showing how doctors grapple with prioritising radiotherapy is here. It makes one understand the complex issues facing doctors when resources are stretched.