{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T01:45:26Z","timestamp":1791769526585,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess to what extent hospitals meet the uniform English National Health Service \u2018timely\u2019 treatment standard, what happens after a breach, and determinants of delay for patients with high\u2010risk renal cell carcinoma (RCC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Methods<\/jats:title>\n                    <jats:p>Population\u2010based study using linked data for 7030 patients with high\u2010risk and 10\u2009708 patients with low\u2010risk RCC, 2019\u20132023. The probabilities of \u2018timely\u2019 treatment and prolonged delay (\u226431\u2009days or &gt;62\u2009days from decision\u2010to\u2010treat, respectively) were estimated using multilevel logistic regression. Daily treatment probabilities beyond 31\u2009days were represented using smoothed hazard rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For a typical patient with high\u2010risk RCC, timely treatment declined from 83.7% (2019) to 64.8% (2023), with a corresponding decline in the low\u2010risk group from 71.3% to 47.6%, while prolonged delays more than doubled, from 3.9% to 9.4%. Patients with high\u2010risk RCC were prioritised over those with low\u2010risk disease (73.6% vs 58.2%; adjusted risk ratio 1.26, 95% confidence interval 1.22\u20131.31). Older and more socioeconomically deprived patients experienced longer delays. Once the standard was breached, the daily probability of surgery declined sharply. Adjusted percentages of patients with high\u2010 and low\u2010risk RCC treated within the standard were strongly correlated (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.78).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prioritisation of patients with high\u2010risk RCC was maintained throughout the study period but did not prevent a system\u2010wide decline in timely treatment. Patients who breach the timely treatment standard face diminishing daily probabilities of surgery. Risk\u2010stratified standards, ring\u2010fenced surgical capacity, and monitoring beyond defined timely treatment standards are needed to safeguard patients against delays that have significant prognostic implications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70490","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T01:29:51Z","timestamp":1791768591000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical waiting times in patients with high\u2010 and low\u2010risk renal cell carcinoma in England"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8149-9904","authenticated-orcid":false,"given":"Raghav","family":"Varma","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5140-8495","authenticated-orcid":false,"given":"Emily","family":"Mayne","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5404-6088","authenticated-orcid":false,"given":"Will","family":"Cuningham","sequence":"additional","affiliation":[{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3278-9491","authenticated-orcid":false,"given":"Marina A.","family":"Parry","sequence":"additional","affiliation":[{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8572-2832","authenticated-orcid":false,"given":"Arjun","family":"Nathan","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelia","family":"Chen","sequence":"additional","affiliation":[{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4417-2632","authenticated-orcid":false,"given":"Adrian","family":"Cook","sequence":"additional","affiliation":[{"name":"National Cancer Audit Collaborating Centre, Clinical Effectiveness Unit Royal College of Surgeons of England  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6034-4433","authenticated-orcid":false,"given":"Maxine G. 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