Time to treatment initiation (TTI)
Oncology Health Services
Definition. Time to treatment initiation (TTI) is the interval between the date of cancer diagnosis and the start of the first cancer-directed treatment, such as surgery, systemic therapy or radiotherapy.
Explanation
In a study of more than 3.6 million patients in the US National Cancer Database, median TTI for common early-stage solid tumours rose from 21 to 29 days between 2004 and 2013, and longer TTI was associated with worse overall survival in several cancers treated with curative intent (Khorana et al., 2019). A systematic review and meta-analysis found that even a four-week delay in surgery, systemic treatment or radiotherapy was associated with higher mortality for most of the indications studied (Hanna et al., 2020).
For managers, TTI is a pathway-level indicator: it adds up diagnostic, referral, tumour board, scheduling and capacity delays. A rise in TTI should therefore be broken down into its segments before action is taken, and the start date (biopsy, pathology report or first specialist visit) must be stated, because studies define it differently. The chapter on oncology performance management shows how TTI moves from a target and threshold to a management decision.
Related concepts
Waiting time Patient journey Multidisciplinary tumour board (MDT) Key performance indicator (KPI)
Read on The Health Topics
- Performance Management in the Oncology Hospital: From KPI to Management Decision. An Introduction (101)
- Resource, Quality and Data-Driven Management in the Oncology Hospital: An Introduction (101) for Physicians
- The Patient Journey in Oncology: Access, Waiting, Referral and Transitions
- Managing an Oncology Hospital as a System: Patient Journey, Process, Bottleneck and Capacity
References
Hanna, T. P., King, W. D., Thibodeau, S., Jalink, M., Paulin, G. A., Harvey-Jones, E., O’Sullivan, D. E., Booth, C. M., Sullivan, R., & Aggarwal, A. (2020). Mortality due to cancer treatment delay: Systematic review and meta-analysis. BMJ, 371, m4087. https://doi.org/10.1136/bmj.m4087
Khorana, A. A., Tullio, K., Elson, P., Pennell, N. A., Grobmyer, S. R., Kalady, M. F., Raymond, D., Abraham, J., Klein, E. A., Walsh, R. M., Monteleone, E. E., Wei, W., Hobbs, B., & Bolwell, B. J. (2019). Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLOS ONE, 14(3), e0213209. https://doi.org/10.1371/journal.pone.0213209
Cite this entry: Kurutkan, M. N. (2026). Time to treatment initiation (TTI). In The Health Topics glossary. https://healthtopic.org/glossary/time-to-treatment-initiation/
Articles that discuss this concept
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