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Weekend Delay in Initiation of Chemotherapy for Acute Lymphoblastic Leukemia: Does it Matter?

The Friday afternoon admission of a child with a potential diagnosis of leukemia creates perceived delays in treatment initiation. Although generally not felt to affect prognosis, the effect of a few days delay in chemotherapy for children with acute lymphoblastic leukemia (ALL) has not been fully investigated. We retrospectively analyzed 207 patients consecutively diagnosed with ALL at Children’s Hospital & Research Center Oakland from 1995 to 2007 to determine if delay in chemotherapy increased the risk of relapse, death, transfer to the intensive care unit, or bacteremia. Friday admission did not significantly delay chemotherapy initiation with treatment started at a mean of 4.13±2.40 days for Friday admits versus 3.72±1.57 days for all others (P=0.29). There was no significant association between treatment delay days and relapse (P=0.94) or death (P=0.55). In Cox regression analysis, treatment delay was not a predictor of time to relapse (P=0.80) or longer duration of hospitalization (corrected for delay, P=0.15). There were trends toward significant associations between treatment delay and bacteremia (P=0.07) and intensive care unit admissions (P=0.08), although both were associated with shorter, not longer, treatment delays. We were unable to demonstrate a significant effect of delay in chemotherapy initiation for pediatric patients with newly diagnosed ALL on the examined outcome variables.