Factors associated with wait times across the breast cancer treatment pathway in Ontario

Abstract

BackgroundLonger times from diagnosis to breast cancer treatment are associated with poorer prognosis. This study examined factors associated with wait times by phase in the breast cancer treatment pathway.MethodsThere were 1760 women eligible for the study, aged 50–69 diagnosed in Ontario with invasive breast cancer from 1995–2003. Multivariate logistic regression examined factors associated with greater than median wait times for each phase of the treatment pathway; from diagnosis to definitive surgery; from final surgery to radiotherapy without chemotherapy and from final surgery to chemotherapy.ResultsThe median wait times were 17 days (Inter Quartile Range (IQR) = 0–31) from diagnosis to definitive surgery, 44 days (IQR = 34–56) from final surgery to postoperative chemotherapy and 75 days (IQR = 57–97) from final surgery to postoperative radiotherapy. Diagnosis during 2000–2003 compared to 1995–1999 was associated with significantly longer wait times for each phase of the treatment pathway. Higher income quintile was associated with longer wait time from diagnosis to surgery (OR = 1.47, 95% CI = 1.05-2.06) and shorter wait times from final surgery to radiotherapy (OR = 0.60, 95% CI = 0.37-0.96). Greater stage at diagnosis was associated with shorter wait times from diagnosis to definitive surgery (stage III vs I: OR = 0.49, 95% CI = 0.34-0.71).ConclusionsWhile diagnosis during the latter part of the study period was associated with significantly longer wait times for all phases of the treatment pathway, there were variations in the associations of stage and income quintile with wait times by treatment phase. Continued assessment of factors associated with wait times across the breast cancer treatment pathway is important, as they indicate areas to be targeted for quality improvement with the ultimate goal of improving prognosis.

Impact of Medicaid disenrollment in Tennessee on breast cancer stage at diagnosis and treatment

“…22 Nevertheless, the rates in the sample are consistent with trends noted in Tennessee. 25 There are several potential explanations for the findings of the current study regarding late stage of disease at the time of diagnosis and fewer delays in receipt of surgery and treatment for low-income women. Women living in high-income zip codes were found to be less likely to experience delays in the period before disenrollment compared with women living in low-income zip codes, and yet women living in high-income zip codes experienced a larger increase in delays in the period after disenrollment.…”

Understanding process-of-care delays in surgical treatment of breast cancer at a comprehensive cancer center

“…In part, this may be due to the focus of our study. Most of the previous researches demonstrating disparities in care timeliness have focused on the time from presentation of symptoms or initial diagnosis to definitive surgery, as opposed to our exploration of processes of care once a patient is seen at our cancer center [5,8].…”

“…Inefficient processes represent organizational factors that may be more readily amenable to measurement, management, and modification than the sociodemographic and disease-specific factors that have emerged from prior epidemiologic studies of care delays [5][6][7][8][9][10]. For example, the use of a breast care triage program was shown to increase the percent of appropriate referrals for breast surgical consultation and to reduce wait times to consultation [13].…”

“…Timely care is a core dimension of quality according to organizations such as the Institute of Medicine, the American Society of Clinical Oncology (ASCO), and the National Comprehensive Center Network (NCCN) [3,4]. Despite the focus on improving efficiency and timeliness of care, researchers continue to demonstrate patient and health system factors that delay definitive care, putting women at risk of inferior outcomes [5][6][7][8][9][10][11][12].…”

Surveillance of waiting times for access to treatment: a registry-based computed approach in breast cancer care

“…) and worldwide (Plotogea et al . ; Vandergrift et al . ), and it highlights inequalities in access to treatment between geographical areas.…”