Waiting Time for Breast Cancer Treatment in Alberta
Reed, Alyssa D., Williams, Robert J., Wall, Patricia A., Hasselback, Paul, Canadian Journal of Public Health
Background: The present study had two research questions. First, what is the average waiting time between diagnosis and treatment for Alberta women with breast cancer relative to Canadian Society for Surgical Oncology (CSSO) recommendations? Second, does patient age, cancer stage, patient community size, and year of diagnosis have a significant relationship to waiting time?
Methods: The sample consisted of all Alberta women diagnosed with breast cancer between 1997 and 2000. Waiting time was defined as number of days between definitive diagnosis and treatment initiation. Multiple regression examined the relative influence of the predictor variables on waiting time.
Results: There were 6,418 cases of breast cancer between 1997 and 2000. Mean waiting time was 20.2 days (SD 21.6) and median waiting time was 17 days. Longer waiting time was significantly associated with year of diagnosis (progressively longer from 1997 to 2000), patients younger than 70, and Stage 1 cancer. Waiting time increase from 1997 to 2000 appears to be due to increased demand for services without corresponding increases in resources. Less treatment delay for women older than 70 is due to more of these women being treated the same day they received their diagnosis.
Conclusion: Only 44% of women had a waiting time of 14 days or less as recommended by the CSSO. The number of women who will have to wait longer than recommended for treatment will likely increase without a significant increase in oncological resources. The basis for differences in waiting times as a function of age needs to be further investigated to ensure equitable access to care.
Breast cancer has a significant impact on women's health. In Canada, it is the most commonly diagnosed cancer among women (excluding nonmelanoma skin cancer) and the second leading cause of female cancer deaths.1 In their lifetime, 1 in 9 Canadian women will be diagnosed with breast cancer and 1 in 26 will die from it.1 There is currently no known primary prevention for breast cancer. As a result, early detection and treatment are the best options for improving outcomes.2 Accordingly, the Canadian Society for Surgical Oncology (CSSO) has recommended that no more than two weeks transpire between diagnosis and treatment.3
Delays are related to increased patient distress.4-8 However, there is contradictoiy evidence regarding the effect that treatment delay has on survival. Some researchers have found improved survival rates with shorter delays,9-21 whereas others have failed to find a difference,22-27 and one recent study reported better survival with longer delays.28 The nature of the tumour may help explain these conflicting findings. Some investigators have found that patients with fast-growing tumours are negatively impacted by delays, whereas outcome for patients with slow-growing tumours is independent of waiting time.17,21 Given the difficulty in determining the nature of the tumour at first contact, timely diagnosis and treatment would ensure the best chance for a positive outcome.
The actual waiting times that women experience vary according to jurisdiction and the year(s) the study was conducted. Table I summarizes waiting times found in other studies.6,28-35 It is difficult to make comparisons between studies because of differences in the waiting time intervals being measured. The three studies with waiting times comparable to the present study (diagnosis to treatment initiation) found intervals ranging from 10 to 24 days.33-35
In order to decrease waiting times, it is important to identify factors predictive of delay. Table II summarizes studies examining this issue.6,17,23,2,34-43 Most studies report younger age to be a risk factor for delay. The basis for this association is unclear, although some authors have speculated it is because physicians are more suspicious of breast cancer in older women and refer them to a specialist more quickly,28 Most studies have also found that the absence of a breast lump is related to longer delay,35-37,39 The reason for this may be that physicians are more likely to attribute a lump to possible cancer compared to other breast symptoms, Similarly, there is consistent evidence that women with malignant breast disease experience less delay before treatment than women with benign conditions,6,43,43 All studies in Table II have found significant regional variation in waiting times. …