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This retrospective cohort study evaluates trends in time to treatment initiation (TTI), examines the association between TTI and survival, and determines predictors of TTI across HPB malignancies. Methods: Patients with pancreas, liver, and bile duct cancers (2004–2017) from the National Cancer Database were analyzed using Kaplan-Meier and Cox regression.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/hepatopancreatobiliary-malignancies-time-to-treatment-matters/377864/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/hepatopancreatobiliary-malignancies-time-to-treatment-matters/377864.png","ImageObject",300,407,{"name":92,"@type":93},"Riley","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-25","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main focus of this study on hepatopancreatobiliary cancers?","Question",{"text":112,"@type":113},"The study focuses on trends in time to treatment initiation (TTI), how TTI relates to survival, and which factors predict longer TTI in HPB cancers.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was TTI associated with overall survival in the results?",{"text":117,"@type":113},"Longer TTI was associated with increased mortality, especially in stage I–III extrahepatic bile duct cancer and stage I–II pancreatic adenocarcinoma.",{"name":119,"@type":110,"acceptedAnswer":120},"Which patient groups were linked to delays in treatment?",{"text":121,"@type":113},"The study found that Black and Hispanic patients experienced greater delays in care than white patients.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},377864,1790508451,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36},1374391975076,"https://ap-avatar.wpscdn.com/avatar/14000253ca4ec9f6853?x-image-process=image/resize,m_fixed,w_180,h_180&k=1783305029341752051","Hepatopancreatobiliary malignancies: time to treatment matters  \nDaniel M. Kerekes1^, Alexander E. Frey1, Baylee F. Bakkila2, Caroline H. Johnson3, Robert D. Becher1, Kevin G. Billingsley1, Sajid A. Khan1  \n1Department of Surgery, Yale School of Medicine, New Haven, CT, USA; 2Yale School of Medicine, New Haven, CT, USA; 3Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA  \nContributions: (I) Conception and design: DM Kerekes, AE Frey, SA Khan; (II) Administrative support: DM Kerekes; (III) Provision of study materials or patients: SA Khan; (IV) Collection and assembly of data: DM Kerekes, AE Frey; (V) Data analysis and interpretation: DM Kerekes, AE Frey, SA Khan, KG Billingsley; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Sajid A. Khan, MD. Associate Professor of Surgery (Oncology), Yale School of Medicine, PO Box 208062, New Haven, CT 06520-  \n8062, USA. Email: [Sajid.Khan@yale.edu](Sajid.Khan@yale.edu).  \nBackground: Initiation of oncologic care is often delayed, yet little is known about delays in hepatopancreatobiliary (HPB) cancers or their impact. This retrospective cohort study describes trends in time to treatment initiation (TTI), assesses the association between TTI and survival, and identifies  \npredictors ofTTI in HPB cancers.  \nMethods: The National Cancer Database was queried for patients with cancers of the pancreas, liver, and bile ducts between 2004 and 2017. Kaplan-Meier survival analysis and Cox regression were used to investigate the association between TTI and overall survival for each cancer type and stage. Multivariable  \nregression identified factors associated with longer TTI.  \nResults: Of 318,931 patients with HPB cancers, median TTI was 31 days. Longer TTI was associated with increased mortality in patients with stages I–III extrahepatic bile duct (EHBD) cancer and stages I– II pancreatic adenocarcinoma. Patients treated within 3–30, 31–60, and 61–90 days had median survivals of  \n51.5, 34.9, and 25.4 months (log-rank P\u003C0.001), respectively, for stage I EHBD cancer, and 18.8, 16.6, and  \n15.2 months for stage I pancreatic cancer, respectively (P\u003C0.001) . Factors associated with increased TTI included stage I disease (+13.7 days vs. stage IV, P\u003C0.001), treatment with radiation only (β=+13.9 days,  \nP\u003C0.001), Black race (+4.6 days, P\u003C0.001) and Hispanic ethnicity (+4.3 days, P\u003C0.001) .  \nConclusions: Some HPB cancer patients with longer time to definitive care experienced higher mortality than patients treated expeditiously, particularly in non-metastatic EHBD cancer. Black and Hispanic patients  \nare at risk for delayed treatment. Further research into these associations is needed.  \nKeywords: Bile ducts, extrahepatic; time-to-treatment; survival analysis; health inequities  \nSubmitted Nov 02, 2022. Accepted for publication Mar 21, 2023. Published online Apr 17, 2023.  \ndoi: 10.21037/jgo-22-1067  \nView this article at: [https://dx.doi.org/10.21037/jgo-22-1067](https://dx.doi.org/10.21037/jgo-22-1067)  \nIntroduction  \nThe increasing complexity of cancer care is driving a national trend towards increasing time from diagnosis to treatment initiation for many cancers (1-3) . Moreover, resource constraints due to the COVID-19 pandemic have  \nexacerbated existing delays by forcing many institutions to systematically postpone cancer treatment further (4-7) . On a case-by-case basis, due to the complexity, cost, and duration of care, treatment for an individual may be further delayed for a multitude of patient- , provider- , or facility-driven  \n^ ORCID: 0000-0001-9467-1486.  \n© Journal of Gastrointestinal Oncology. All rights reserved. J Gastrointest Oncol 2023;14(2):833-848 | [https://dx.doi.org/10.21037/jgo-22-1067](https://dx.doi.org/10.21037/jgo-22-1067)  \n834 Kerekes et al. Treatment delay in HPB cancers  \nreasons. However, the impact of delays in oncologic care on patient outcom","cbCainIZ2NMyb3wi","https://ap.wps.com/l/cbCainIZ2NMyb3wi","pdf",989120,16,"English","# Introduction\n## Background and rationale\n# Methods\n## Data source and statistical approach\n# Results\n## Time to treatment initiation and survival associations\n## Factors associated with longer TTI\n# Conclusions\n## Clinical implications and need for further research","[{\"question\":\"What is the main focus of this study on hepatopancreatobiliary cancers?\",\"answer\":\"The study focuses on trends in time to treatment initiation (TTI), how TTI relates to survival, and which factors predict longer TTI in HPB cancers.\"},{\"question\":\"How was TTI associated with overall survival in the results?\",\"answer\":\"Longer TTI was associated with increased mortality, especially in stage I–III extrahepatic bile duct cancer and stage I–II pancreatic adenocarcinoma.\"},{\"question\":\"Which patient groups were linked to delays in treatment?\",\"answer\":\"The study found that Black and Hispanic patients experienced greater delays in care than white patients.\"}]","Hepatopancreatobiliary malignancies: time to treatment matters | PDF",1790227437]