{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:38:59Z","timestamp":1787809139134,"version":"build-2784847793"},"reference-count":24,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Time to treatment initiation (TTI) has been identified as a predictor of survival in many cancers, but its impact on malignant pleural mesothelioma (MPM) is unknown. This study investigates factors influencing TTI in MPM and its association with overall survival. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to obtain data for MPM patients in the United States. TTI was defined as the number of days from diagnosis to initiation of first treatment, and delayed TTI was defined as exceeding the median TTI. \u03a72 tests and t-tests compared sociodemographic and clinical differences between early and delayed TTI groups, while Kaplan\u2013Meier and Cox proportional hazards models evaluated relationships between prognostic factors, TTI, and survival. Results: Among 4879 MPM patients, the median TTI was 39 days. Median survival was 10 months among early TTI patients and 13 months among delayed TTI patients. Patients with epithelioid histology were more likely to have delayed TTI, as were patients who received combination therapy or were diagnosed more recently (p &lt; 0.0001). Adjusting for covariates, delayed TTI status remained associated with better survival (HR 0.79, 95% CI: 0.74\u20130.84). Conclusions: This study presents an important insight into the management of MPM, demonstrating that delayed time to treatment initiation is positively associated with improved overall survival, contrary to findings in most cancers. This finding underscores the importance of comprehensive, multidisciplinary care, as delays due to robust staging evaluations and patient travel to high-volume centers of excellence likely contribute to delays in treatment. Taken together, these results suggest that clinicians should prioritize personalized treatment planning and collaborative care over a push to rapidly initiate treatment to optimize patient outcomes in MPM.<\/jats:p>","DOI":"10.3390\/cancers16223755","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T04:22:56Z","timestamp":1730953376000},"page":"3755","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Paradoxical Improvement in Malignant Pleural Mesothelioma Outcomes Following Delayed Treatment Initiation"],"prefix":"10.3390","volume":"16","author":[{"given":"Ashwin","family":"Kulshrestha","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Taioli","sequence":"additional","affiliation":[{"name":"Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wolf","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Tuminello","sequence":"additional","affiliation":[{"name":"Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12208","DOI":"10.1002\/cam4.5915","article-title":"Epidemiological, therapeutic, and survival trends in malignant pleural mesothelioma: A review of the National Cancer Database","volume":"12","author":"Chang","year":"2023","journal-title":"Cancer Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1002\/ajim.22955","article-title":"North-south gradient of mesothelioma and asbestos consumption-production in the United States-Progresses since the 1st asbestos partial ban in 1973","volume":"62","author":"Sun","year":"2019","journal-title":"Am. J. Ind. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.21037\/tlcr.2019.11.11","article-title":"Epidemiology of mesothelioma in the 21st century in Europe and the United States, 40 years after restricted\/banned asbestos use","volume":"9","author":"Alpert","year":"2020","journal-title":"Transl. Lung Cancer Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1200\/JCO.2017.76.6394","article-title":"Treatment of malignant pleural mesothelioma: American Society of Clinical Oncology clinical practice guideline","volume":"36","author":"Kindler","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.annonc.2021.11.005","article-title":"Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"33","author":"Popat","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"825","DOI":"10.6004\/jnccn.2016.0087","article-title":"NCCN guidelines insights: Malignant pleural mesothelioma, version 3.2016","volume":"14","author":"Ettinger","year":"2016","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.soc.2020.06.002","article-title":"Updates in staging and management of malignant pleural mesothelioma","volume":"29","author":"Wolf","year":"2020","journal-title":"Surg. Oncol. Clin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S0140-6736(20)32714-8","article-title":"First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): A multicentre, randomised, open-label, phase 3 trial","volume":"397","author":"Baas","year":"2021","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.athoracsur.2016.08.063","article-title":"Amount of epithelioid differentiation is a predictor of survival in malignant pleural mesothelioma","volume":"103","author":"Vigneswaran","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e583","DOI":"10.1016\/j.cllc.2020.05.021","article-title":"Gender-based disparities in receipt of care and survival in malignant pleural mesothelioma","volume":"21","author":"Barsky","year":"2020","journal-title":"Clin. Lung Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Alnajar, A., Kareff, S.A., Razi, S.S., Rao, J.S., Lopes, G.D.L., Nguyen, D.M., Villamizar, N., and Rodriguez, E. (2023). Disparities in survival due to social determinants of health and access to treatment in US patients with operable malignant pleural mesothelioma. JAMA Netw. Open, 6.","DOI":"10.1001\/jamanetworkopen.2023.4261"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Cone, E.B., Marchese, M., Paciotti, M., Nguyen, D.-D., Nabi, J., Cole, A.P., Molina, G., Molina, R.L., Minami, C.A., and Mucci, L.A. (2020). Assessment of time-to-treatment initiation and survival in a cohort of patients with common cancers. JAMA Netw. Open, 3.","DOI":"10.1001\/jamanetworkopen.2020.30072"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1200\/JCO.2015.61.5906","article-title":"Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States","volume":"34","author":"Murphy","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1016\/S0022-5347(05)00644-0","article-title":"Cystectomy delay more than 3 months from initial bladder cancer diagnosis results in decreased disease specific and overall survival","volume":"175","author":"Lee","year":"2006","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S0167-8140(00)00257-7","article-title":"The effect of waiting for radiotherapy for grade III\/IV gliomas","volume":"57","author":"Do","year":"2000","journal-title":"Radiother. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1016\/j.cllc.2020.09.004","article-title":"The effects of time to treatment initiation for patients with non\u2013small-cell lung cancer in the United States","volume":"22","author":"Cushman","year":"2021","journal-title":"Clin. Lung Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6692","DOI":"10.1245\/s10434-022-11971-w","article-title":"Racial disparities in time to treatment persist in the setting of a comprehensive breast center","volume":"29","author":"Zaveri","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"18258","DOI":"10.1002\/cam4.6419","article-title":"Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act","volume":"12","author":"Corriher","year":"2023","journal-title":"Cancer Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/COC.0000000000000744","article-title":"Racial disparities in time to treatment initiation and outcomes for early stage anal squamous cell carcinoma","volume":"43","author":"Goksu","year":"2020","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_20","unstructured":"National Cancer Institute (2022). Surveillance, epidemiology, and end results (SEER) program. Cancer Statistics, SEER Data & Software, Registry Operations, National Cancer Institute."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.cllc.2022.09.003","article-title":"Comparison of survival by multimodal treatment regimen among malignant pleural mesothelioma patients in an integrated health system","volume":"23","author":"Banks","year":"2022","journal-title":"Clin. Lung Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/S2213-2600(24)00119-X","article-title":"Extended pleurectomy decortication and chemotherapy versus chemotherapy alone for pleural mesothelioma (MARS 2): A phase 3 randomised controlled trial","volume":"12","author":"Lim","year":"2024","journal-title":"Lancet Respir. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gulati, S., Wolf, A.S., and Flores, R.M. (2024, November 04). Should treatment of mesothelioma include surgery? MARS2 fails to land. In Seminars in Thoracic and Cardiovascular Surgery. Available online: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1043067924000509.","DOI":"10.1053\/j.semtcvs.2024.07.001"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.1097\/MLR.0000000000000073","article-title":"Comparison of SEER treatment data with Medicare claims","volume":"54","author":"Noone","year":"2016","journal-title":"Med. Care"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/22\/3755\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:42Z","timestamp":1760113662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/22\/3755"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,7]]},"references-count":24,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["cancers16223755"],"URL":"https:\/\/doi.org\/10.3390\/cancers16223755","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,7]]}}}