The Impact of Treatment Delay on Endometrial and Ovarian Cancer Patients: A Systematic Review
Dimitrios Zouzoulas, Tilemachos Karalis, Iliana Sofianou, Christos Anthoulakis, Katerina Tzika, Μenelaos Zafrakas, Eleni Timotheadou, Grigoris Grimbizis, Dimitrios Tsolakidis
Abstract
BACKGROUND/OBJECTIVES: Ovarian and endometrial cancers present significant health burdens due to their substantial morbidity and mortality. Surgery delay is hypothesized to negatively impact patient outcomes, yet evidence remains inconsistent. This systematic review aims to comprehensively evaluate current evidence regarding the effects of treatment delay on survival and quality of life in these patients. METHODS: A systematic literature search was conducted in MEDLINE (PubMed), Cochrane Library, Scopus, and ClinicalTrials.gov databases, complemented by a manual screening of reference lists, with studies included up to March 2025. Two independent reviewers screened and assessed the methodological quality using the ROBINS-E tool and extracted the data from the studies. Due to substantial methodological and clinical heterogeneity, results were synthesized qualitatively through narrative synthesis. RESULTS: Twenty-one studies met the inclusion criteria, comprising predominantly retrospective cohort analyses. Treatment delays consistently correlated with decreased survival and advanced disease stages. Among studies, optimal intervals from diagnosis to treatment were varied from 2 to 8 weeks. Patient-reported outcomes indicated heightened anxiety, increased distress, and poor satisfaction with prolonged delays. Healthcare system factors such as resource allocation, geographic disparities, and socioeconomic inequalities significantly contributed to delays. Quantitative survival metrics supported a clear negative association between treatment delays and survival, although paradoxical outcomes in select subgroups highlighted underlying complexities. CONCLUSIONS: This systematic review underscores the critical importance of minimizing delays in the treatment of ovarian and endometrial cancers to improve patient survival and psychological outcomes. Identified healthcare system barriers demand targeted policy interventions to ensure timely and equitable access to tertiary healthcare infrastructures. Future research should prioritize standardizing delay definitions to strengthen and homogenize evidence.